MEDICARE: BAILEY DEVENPORT CPNP-PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	289342	AZ

General Provider Information

NPI Number	:	1457049207
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY DEVENPORT CPNP-PC

Provider Business Mailing Address
First Line	:	4735 E UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3362
Country	:	US
Telephone Number	:	602-971-5121
Fax Number	:

Provider Business Practice Location Address
First Line	:	4735 E UNION HILLS DR
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85050-3362
Country	:	US
Telephone Number	:	602-971-5121
Fax Number	:	602-242-6945

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/28/2023
Last Update Date	:	02/28/2024

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Directions to “ BAILEY DEVENPORT CPNP-PC” Practice Location

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