Healthcare Provider Details

I. General information

NPI: 1265436141
Provider Name (Legal Business Name): BRIAN KEITH BAILEY D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/23/2024
Certification Date: 09/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 14TH ST
ASHLAND KY
41101-2622
US

IV. Provider business mailing address

500 14TH ST
ASHLAND KY
41101-2622
US

V. Phone/Fax

Practice location:
  • Phone: 606-324-3668
  • Fax: 606-324-0668
Mailing address:
  • Phone: 606-324-3668
  • Fax: 606-324-0668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213EP0504X
TaxonomyPublic Medicine Podiatrist
License Number244094
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00305
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: