Healthcare Provider Details

I. General information

NPI: 1972741478
Provider Name (Legal Business Name): CRYSTAL JEAN BAILEY CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2009
Last Update Date: 01/22/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NEAL ST STE 200
COOKEVILLE TN
38501-0942
US

IV. Provider business mailing address

1080 NEAL ST STE 200
COOKEVILLE TN
38501-0942
US

V. Phone/Fax

Practice location:
  • Phone: 931-520-1529
  • Fax: 931-372-2751
Mailing address:
  • Phone: 931-520-1529
  • Fax: 931-372-2751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number164572
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number13378
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: