Healthcare Provider Details

I. General information

NPI: 1770048514
Provider Name (Legal Business Name): BAILEY IRENE WALKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 RANDOLPH RD
CHARLOTTE NC
28211-1018
US

IV. Provider business mailing address

2080 W ARLINGTON BLVD STE B
GREENVILLE NC
27834-3770
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-1647
  • Fax: 704-358-8267
Mailing address:
  • Phone: 252-752-2140
  • Fax: 252-689-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number317017
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number6172
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024186337
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: