Healthcare Provider Details

I. General information

NPI: 1609703214
Provider Name (Legal Business Name): DERENDER BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41800 W 11 MILE RD NOVI, MI 48375 SUITE 109
NOVI MI
48375
US

IV. Provider business mailing address

115 TOM CHAPMAN BLVD APT 507
WARNER ROBINS GA
31088
US

V. Phone/Fax

Practice location:
  • Phone: 561-385-4455
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN-NP271294
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: