Healthcare Provider Details

I. General information

NPI: 1659840981
Provider Name (Legal Business Name): RACHEL BAILEY NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 02/21/2025
Certification Date: 02/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2680 W CENTRE AVE
PORTAGE MI
49024-4828
US

IV. Provider business mailing address

4687 POUNCEY TRACT RD
GLEN ALLEN VA
23059-5802
US

V. Phone/Fax

Practice location:
  • Phone: 269-324-2400
  • Fax:
Mailing address:
  • Phone: 804-422-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704422895
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0024176625
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: