Healthcare Provider Details

I. General information

NPI: 1497025191
Provider Name (Legal Business Name): JAMIE N. BAILEY CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2012
Last Update Date: 01/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 N BOLTON AVE
ALEXANDRIA LA
71301-7449
US

IV. Provider business mailing address

651 N BOLTON AVE
ALEXANDRIA LA
71301-7449
US

V. Phone/Fax

Practice location:
  • Phone: 318-484-5280
  • Fax: 318-442-3134
Mailing address:
  • Phone: 318-484-5280
  • Fax: 318-442-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP06713
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: