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General NPI Number Information
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NPI Number | 1962664334
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Entity Type | Individual
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Provider Name | IVY MARIE BAGLEY FNP
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Gender | Female
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Dates
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Enumeration Date | 06/27/2008
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Last Update Date | 02/12/2026
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Provider Practice Location Address
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Address Line | 1704 E ARLINGTON BLVD STE B
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City | GREENVILLE
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State | NC
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Zip | 27858-7828
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Country | US
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Telephone | 252-756-4899
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Fax | 252-756-5141
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Provider Business Mailing Address
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Address Line | 1001 BRYSON DR
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City | GREENVILLE
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State | NC
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Zip | 27834-7811
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Country | US
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Telephone | 252-916-6236
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5003886
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License Number State | NC
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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 | 5003886
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License Number State | NC
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