Healthcare Provider Details

I. General information

NPI: 1417575788
Provider Name (Legal Business Name): BAILEY BOYD FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2020
Last Update Date: 06/19/2024
Certification Date: 06/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

350 S CHARLES G SEIVERS BLVD
CLINTON TN
37716-3929
US

IV. Provider business mailing address

129 MEADOWOOD CIR
LA FOLLETTE TN
37766-4540
US

V. Phone/Fax

Practice location:
  • Phone: 865-290-2313
  • Fax:
Mailing address:
  • Phone: 423-494-9803
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000029920
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: