MEDICARE: BAILEY ALEXIS WILLOWS 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
1	363A00000X	Physician Assistant	PA15533	TX

General Provider Information

NPI Number	:	1679223291
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BAILEY ALEXIS WILLOWS PA-C

Provider Business Mailing Address
First Line	:	5449 CHATSWORTH LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5022
Country	:	US
Telephone Number	:	817-455-7756
Fax Number	:

Provider Business Practice Location Address
First Line	:	5449 CHATSWORTH LN
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-5022
Country	:	US
Telephone Number	:	817-455-7756
Fax Number	:

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

Provider Enumeration Date	:	03/26/2022
Last Update Date	:	01/22/2025

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