Healthcare Provider Details

I. General information

NPI: 1003161373
Provider Name (Legal Business Name): AMY BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 10/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 EARL FRYE BLVD SUITE A
AMORY MS
38821-5507
US

IV. Provider business mailing address

900 EARL FRYE BLVD SUITE A
AMORY MS
38821-5507
US

V. Phone/Fax

Practice location:
  • Phone: 662-256-9331
  • Fax: 662-256-9335
Mailing address:
  • Phone: 662-256-9331
  • Fax: 662-256-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR877157
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: