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NPI 1356612873

NPI 1356612873 : DAVID CLARK BAILEY JR. NP-C : NORTHPORT, AL

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General NPI Number Information
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    NPI Number           |    1356612873
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    Entity Type          |    Individual 
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    Provider Name        |    DAVID CLARK BAILEY JR. NP-C
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    01/13/2012
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    Last Update Date     |    03/02/2017
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Provider Practice Location Address
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    Address Line         |    2810 LURLEEN B WALLACE BLVD 
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    City                 |    NORTHPORT
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    State                |    AL
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    Zip                  |    35476-3249
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    Country              |    US
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    Telephone            |    205-333-7670
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    2810 LURLEEN B WALLACE BLVD 
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    City                 |    NORTHPORT
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    State                |    AL
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    Zip                  |    35476-3249
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    Country              |    US
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    Telephone            |    205-333-7670
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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       |    1-077689
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    License Number State |    AL
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