Healthcare Provider Details

I. General information

NPI: 1184348807
Provider Name (Legal Business Name): BAILLEY ALEXIS DANFORTH PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2022
Last Update Date: 12/18/2023
Certification Date: 12/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

506 1ST AVE SE
WATERTOWN SD
57201-4499
US

IV. Provider business mailing address

506 1ST AVE SE
WATERTOWN SD
57201-4499
US

V. Phone/Fax

Practice location:
  • Phone: 605-886-8482
  • Fax: 605-884-4300
Mailing address:
  • Phone: 605-886-8482
  • Fax: 605-884-4300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPAC0970
License Number StateND
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1428
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: