Healthcare Provider Details

I. General information

NPI: 1427277755
Provider Name (Legal Business Name): AMY ELIZABETH BAILEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 E. MATTHEWS SUITE 101
JONESBORO AR
72401
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-972-5937
  • Fax: 870-972-0104
Mailing address:
  • Phone: 870-934-5102
  • Fax: 870-932-3608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberE-5364
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: