Healthcare Provider Details

I. General information

NPI: 1336361658
Provider Name (Legal Business Name): EVERETT HENRY BAYLISS JR. RN CNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121-123 W. MAINE STREET
EMMITSBURG MD
21727
US

IV. Provider business mailing address

PO BOX 3002
GETTYSBURG PA
17325-0002
US

V. Phone/Fax

Practice location:
  • Phone: 301-447-3310
  • Fax:
Mailing address:
  • Phone: 614-507-9604
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR122359
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN700615
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP018374
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR122359
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: