Healthcare Provider Details

I. General information

NPI: 1265114276
Provider Name (Legal Business Name): BAILEY KNAGGS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2023
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

495 GRAND BOULEVARD SUITE 206
MIRIMAR BEACH FL
32550
US

IV. Provider business mailing address

2202 THOMAS DR APT 2406
PANAMA CITY FL
32408-5893
US

V. Phone/Fax

Practice location:
  • Phone: 404-983-6489
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: