Healthcare Provider Details

I. General information

NPI: 1750153094
Provider Name (Legal Business Name): JAMES DUSTIN BAILEY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2023
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

171 S MONROE ST
ASHDOWN AR
71822-3729
US

IV. Provider business mailing address

171 S MONROE ST
ASHDOWN AR
71822-3729
US

V. Phone/Fax

Practice location:
  • Phone: 903-824-6189
  • Fax:
Mailing address:
  • Phone: 903-824-6189
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1196421
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberR101366
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: