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General NPI Number Information
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NPI Number | 1164148359
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Entity Type | Individual
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Provider Name | BAYLEE BANCROFT
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Gender | Female
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Dates
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Enumeration Date | 10/18/2022
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 800 E MAIN ST
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City | MANNINGTON
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State | WV
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Zip | 26582-1278
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Country | US
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Telephone | 681-285-1232
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Fax |
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Provider Business Mailing Address
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Address Line | 338 RICHARD HARRISON WAY
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City | MORGANTOWN
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State | WV
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Zip | 26501-1119
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Country | US
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Telephone | 517-489-9724
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 2759
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License Number State | WV
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