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NPI Code Detail

MEDICARE: MRS. SHRILDA GRADNEY BAILEY FAMILY NURSE PRACTIT

MEDICARE: MRS. SHRILDA GRADNEY BAILEY FAMILY NURSE PRACTIT
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
1163W00000XRegistered NurseRN087065LA
2363LF0000XFamily Nurse PractitionerAP138674TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1RN087065OTHERLAREGISTERED NURSE LICENSE

General Provider Information

NPI Number : 1821539370
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. SHRILDA GRADNEY BAILEY FAMILY NURSE PRACTIT
Provider Business Mailing Address
First Line : 1308 GREEN OAK DR
Second Line : N/A
City : BATON ROUGE
State : LA
Zip : 70815-2026
Country : US
Telephone Number : 817-291-9019
Fax Number : 225-412-4952
Provider Business Practice Location Address
First Line : 1308 GREEN OAK DR
Second Line : N/A
City : BATON ROUGE
State : LA
Zip : 70815-2026
Country : US
Telephone Number : 817-291-9019
Fax Number : 225-412-4952
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/16/2017
Last Update Date : 10/04/2018

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