Healthcare Provider Details

I. General information

NPI: 1356203830
Provider Name (Legal Business Name): BAILEY HERSMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAILEY RANDALL

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4761 TUTTLE CREEK BLVD
MANHATTAN KS
66502-9079
US

IV. Provider business mailing address

318 HUNTER PL APT 204
MANHATTAN KS
66503-8023
US

V. Phone/Fax

Practice location:
  • Phone: 785-587-1825
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: