Healthcare Provider Details

I. General information

NPI: 1487384855
Provider Name (Legal Business Name): CAROLYN BAILEY PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2022
Last Update Date: 06/16/2022
Certification Date: 02/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 KILPATRICK BLVD STE 100
MONROE LA
71201-5156
US

IV. Provider business mailing address

3100 KILPATRICK BLVD
MONROE LA
71201-5156
US

V. Phone/Fax

Practice location:
  • Phone: 318-325-8050
  • Fax: 318-325-5385
Mailing address:
  • Phone: 318-350-9582
  • Fax: 318-325-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number226140
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: