Healthcare Provider Details

I. General information

NPI: 1275792186
Provider Name (Legal Business Name): MICHELE BAILEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 06/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 ELIZABETH ST
CHARLESTON WV
25311-2119
US

IV. Provider business mailing address

501 22ND ST
DUNBAR WV
25064-1711
US

V. Phone/Fax

Practice location:
  • Phone: 304-348-7740
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number29266
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: