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NPI Code Detail

MEDICARE: MS. COURTNEY NICOLE BAYLISS PA-C

MEDICARE: MS. COURTNEY NICOLE BAYLISS PA-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
1363A00000XPhysician AssistantP-ENDINGKS
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1558144972
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. COURTNEY NICOLE BAYLISS PA-C
Provider Business Mailing Address
First Line : 2660 SW 3RD ST
Second Line :
City : TOPEKA
State : KS
Zip : 66606-2442
Country : US
Telephone Number : 785-270-8880
Fax Number :
Provider Business Practice Location Address
First Line : 4502 E 41ST ST
Second Line :
City : TULSA
State : OK
Zip : 74135-2536
Country : US
Telephone Number : 918-660-3842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/17/2023
Last Update Date : 12/09/2025

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