Healthcare Provider Details

I. General information

NPI: 1326879073
Provider Name (Legal Business Name): BAILIE KNOX
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2024
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7950 PARK BLVD N APT 7214
PINELLAS PARK FL
33781-3799
US

IV. Provider business mailing address

7950 PARK BLVD N APT 7214
PINELLAS PARK FL
33781-3799
US

V. Phone/Fax

Practice location:
  • Phone: 217-415-0700
  • Fax:
Mailing address:
  • Phone: 217-415-0700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number2023041792
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: