Healthcare Provider Details

I. General information

NPI: 1992622252
Provider Name (Legal Business Name): BAILEY ROSS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

214 N PRAIRIE ST
FLANDREAU SD
57028-1243
US

IV. Provider business mailing address

1903 WINDERMERE WAY
BROOKINGS SD
57006-3958
US

V. Phone/Fax

Practice location:
  • Phone: 605-997-2433
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR059083
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: