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General NPI Number Information
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NPI Number | 1336813252
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Entity Type | Individual
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Provider Name | BAILEY MARIE DAUGHERTY
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Gender | Female
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Dates
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Enumeration Date | 08/04/2021
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Last Update Date | 12/05/2023
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Provider Practice Location Address
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Address Line | 595 N BROADWAY AVE
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City | HYDRO
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State | OK
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Zip | 73048-8425
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Country | US
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Telephone | 833-274-4174
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Fax | 866-274-4175
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Provider Business Mailing Address
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Address Line | 76642 N 2580 RD
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City | WATONGA
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State | OK
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Zip | 73772
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Country | US
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Telephone | 580-791-3280
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 204967
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R0117295
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License Number State | OK
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