MEDICARE: BAILEY J HOWELL APRN-NP

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	363LP2300X	Primary Care Nurse Practitioner	114920	NE

General Provider Information

NPI Number	:	1528807476
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY J HOWELL APRN-NP

Provider Business Mailing Address
First Line	:	PO BOX 24607
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68124-0607
Country	:	US
Telephone Number	:	402-955-5400
Fax Number	:	402-955-3674

Provider Business Practice Location Address
First Line	:	4825 DODGE ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68132-3110
Country	:	US
Telephone Number	:	402-955-7676
Fax Number	:	402-955-7679

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

Provider Enumeration Date	:	05/21/2024
Last Update Date	:	05/21/2024

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