Healthcare Provider Details

I. General information

NPI: 1720934078
Provider Name (Legal Business Name): BAILEY HENINGER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BAILEY WALL MSN

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5506 ROAD 68
PASCO WA
99301-9627
US

IV. Provider business mailing address

PO BOX 31001
PASADENA CA
91110-0001
US

V. Phone/Fax

Practice location:
  • Phone: 425-207-5155
  • Fax:
Mailing address:
  • Phone: 425-207-5155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP.AP.70120928-NP
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberARNP.AP.70120928-NP
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: