Healthcare Provider Details

I. General information

NPI: 1497640189
Provider Name (Legal Business Name): BAILEY BREEDLOVE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 CALHOUN ST
CHARLESTON SC
29401-1113
US

IV. Provider business mailing address

177 THOUSAND OAKS CIR
GOOSE CREEK SC
29445-7094
US

V. Phone/Fax

Practice location:
  • Phone: 843-724-2450
  • Fax: 843-724-2455
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number32044
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: