Healthcare Provider Details

I. General information

NPI: 1346153343
Provider Name (Legal Business Name): BAILEY SLADE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10016 N LIMESTONE WAY
HIGHLAND UT
84003-6005
US

IV. Provider business mailing address

10016 N LIMESTONE WAY
HIGHLAND UT
84003-6005
US

V. Phone/Fax

Practice location:
  • Phone: 602-350-1968
  • Fax:
Mailing address:
  • Phone: 602-350-1968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10444795-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: