Healthcare Provider Details

I. General information

NPI: 1558283820
Provider Name (Legal Business Name): BAILEY JADE BENNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 THUNDERSTICK DR
LEXINGTON KY
40505-9010
US

IV. Provider business mailing address

1152 HORSEMANS LN APT 3202
LEXINGTON KY
40504-2744
US

V. Phone/Fax

Practice location:
  • Phone: 859-254-1035
  • Fax:
Mailing address:
  • Phone: 310-493-7048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: