Healthcare Provider Details

I. General information

NPI: 1821539370
Provider Name (Legal Business Name): SHRILDA GRADNEY BAILEY FAMILY NURSE PRACTIT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHRILDA ANN BAILEY FAMILY NURSE PRACTIT

II. Dates (important events)

Enumeration Date: 03/16/2017
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 GREEN OAK DR N/A
BATON ROUGE LA
70815-2026
US

IV. Provider business mailing address

1308 GREEN OAK DR N/A
BATON ROUGE LA
70815-2026
US

V. Phone/Fax

Practice location:
  • Phone: 817-291-9019
  • Fax: 225-412-4952
Mailing address:
  • Phone: 817-291-9019
  • Fax: 225-412-4952

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP138674
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN087065
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: