Healthcare Provider Details

I. General information

NPI: 1003502808
Provider Name (Legal Business Name): JEFFREY LEWIS BAILEY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2023
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4815 N ASSEMBLY ST
SPOKANE WA
99205-6185
US

IV. Provider business mailing address

PO BOX 871
DEER PARK WA
99006-0871
US

V. Phone/Fax

Practice location:
  • Phone: 509-434-7000
  • Fax:
Mailing address:
  • Phone: 425-238-4733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN61090270
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: