Healthcare Provider Details

I. General information

NPI: 1801428255
Provider Name (Legal Business Name): ADAYA ALEXANDRA BAYLESS CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2020
Last Update Date: 01/09/2022
Certification Date: 01/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3234 MILLER AVE
CROSSVILLE TN
38555-6116
US

IV. Provider business mailing address

4435 SHANGRI LA DR
KNOXVILLE TN
37914-3465
US

V. Phone/Fax

Practice location:
  • Phone: 865-244-0927
  • Fax: 931-456-0802
Mailing address:
  • Phone: 865-244-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number222015
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number222015
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: