MEDICARE: JESSICA JANAY BAILEY MNSC, APRN, NP-C

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	363LF0000X	Family Nurse Practitioner	A005993	AR
2	163W00000X	Registered Nurse	R77410	AR

General Provider Information

NPI Number	:	1538638275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA JANAY BAILEY MNSC, APRN, NP-C

Provider Business Mailing Address
First Line	:	1400 LESLIE ST
Second Line	:
City	:	NASHVILLE
State	:	AR
Zip	:	71852-4027
Country	:	US
Telephone Number	:	870-845-1933
Fax Number	:	870-845-1953

Provider Business Practice Location Address
First Line	:	1400 LESLIE ST
Second Line	:
City	:	NASHVILLE
State	:	AR
Zip	:	71852-4027
Country	:	US
Telephone Number	:	870-845-1933
Fax Number	:	870-845-1953

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

Provider Enumeration Date	:	11/23/2018
Last Update Date	:	11/29/2018

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