Healthcare Provider Details

I. General information

NPI: 1053102459
Provider Name (Legal Business Name): BAILEY KRENEK IBCLC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2025
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2528 COUNTY ROAD 453
EL CAMPO TX
77437-6778
US

IV. Provider business mailing address

2528 COUNTY ROAD 453
EL CAMPO TX
77437-6778
US

V. Phone/Fax

Practice location:
  • Phone: 979-217-1724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License NumberL-302040
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: