Healthcare Provider Details

I. General information

NPI: 1467886275
Provider Name (Legal Business Name): BRANDON JAMES BAILEY APRN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 N WALNUT ST
MEDICINE LODGE KS
67104-1019
US

IV. Provider business mailing address

6720 E SEDONA ST
DERBY KS
67037-9408
US

V. Phone/Fax

Practice location:
  • Phone: 620-886-3771
  • Fax:
Mailing address:
  • Phone: 785-806-3419
  • Fax: 785-460-1490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number76112
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number76112
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number76112
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License Number76112
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number76112
License Number StateKS
# 6
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number76112
License Number StateKS
# 7
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number557653
License Number StateKS
# 8
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number2021039113
License Number StateMO
# 9
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number27175
License Number StateSC
# 10
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number43-557653
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: