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General NPI Number Information
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NPI Number | 1669653952
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Entity Type | Individual
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Provider Name | KRISTINE BAILEY PMHNP
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Gender | Female
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Dates
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Enumeration Date | 11/15/2007
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Last Update Date | 11/30/2010
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Provider Practice Location Address
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Address Line | 305 E FAIRMOUNT AVE STE 7
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City | LAKEWOOD
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State | NY
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Zip | 14750-2000
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Country | US
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Telephone | 716-483-2603
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Fax | 716-526-4161
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Provider Business Mailing Address
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Address Line | 305 E FAIRMOUNT AVE STE 7
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City | LAKEWOOD
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State | NY
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Zip | 14750-2000
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Country | US
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Telephone | 716-483-2603
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Fax | 716-526-4161
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 564481
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | F401349-1
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License Number State | NY
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