Healthcare Provider Details

I. General information

NPI: 1881237972
Provider Name (Legal Business Name): JENNIFER BAILEY FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIFER MOTHERSHED

II. Dates (important events)

Enumeration Date: 10/22/2019
Last Update Date: 12/23/2024
Certification Date: 12/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

49 ROCK SPRINGS RD
CONOWINGO MD
21918-1352
US

IV. Provider business mailing address

PO BOX 99
CONOWINGO MD
21918-0099
US

V. Phone/Fax

Practice location:
  • Phone: 410-378-9696
  • Fax: 410-378-9922
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR182403
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR182403
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR182403
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: