Healthcare Provider Details

I. General information

NPI: 1619603560
Provider Name (Legal Business Name): BAILEY ELIZABETH COLEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2022
Last Update Date: 05/23/2026
Certification Date: 05/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 WILHITE DR
LEXINGTON KY
40503-3385
US

IV. Provider business mailing address

430 BARKLEY DR
LEXINGTON KY
40503-1849
US

V. Phone/Fax

Practice location:
  • Phone: 859-278-6031
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP61328032
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: