Healthcare Provider Details

I. General information

NPI: 1346984184
Provider Name (Legal Business Name): BAILEY JENSEN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2022
Last Update Date: 04/27/2022
Certification Date: 04/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 OVERTHRUST RD
EVANSTON WY
82930-9261
US

IV. Provider business mailing address

191 OVERTHRUST RD
EVANSTON WY
82930-9261
US

V. Phone/Fax

Practice location:
  • Phone: 307-789-8721
  • Fax: 307-789-8664
Mailing address:
  • Phone: 307-789-8721
  • Fax: 307-789-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25204
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: