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NPI Code Detail

MEDICARE: MS. AMANDA N BAILEY REPT, CNIM

MEDICARE: MS. AMANDA N BAILEY REPT, CNIM
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
1246ZE0500XEEG Specialist/Technologist4023TX
22472E0500XEEG Technician4023TX
3246ZE0600XElectroneurodiagnostic Specialist/Technologist

General Provider Information

NPI Number : 1720435340
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. AMANDA N BAILEY REPT, CNIM
Provider Business Mailing Address
First Line : 1356 OLD CREEK DR
Second Line :
City : TYLER
State : TX
Zip : 75703-7642
Country : US
Telephone Number : 903-534-8812
Fax Number : 903-939-9149
Provider Business Practice Location Address
First Line : 1356 OLD CREEK DR
Second Line :
City : TYLER
State : TX
Zip : 75703-7642
Country : US
Telephone Number : 903-534-8812
Fax Number : 903-939-9149
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2016
Last Update Date : 04/22/2019

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