Healthcare Provider Details

I. General information

NPI: 1275057184
Provider Name (Legal Business Name): KELLY MARIE BAILEY AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2017
Last Update Date: 07/27/2025
Certification Date: 07/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

715 CLINIC DR RM 1042
WEST LAFAYETTE IN
47907-2122
US

IV. Provider business mailing address

8753 LILY CT
ZIONSVILLE IN
46077-8535
US

V. Phone/Fax

Practice location:
  • Phone: 317-880-7066
  • Fax: 317-880-0532
Mailing address:
  • Phone: 317-287-4752
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number23002630A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: