Basic Information
| Provider Information | |||||||||
| NPI: | 1194781203 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | C | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1019 W OAKLAND AVE | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042357 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4239155000 | ||||||||
| FaxNumber: | 4239155045 | ||||||||
| Practice Location | |||||||||
| Address1: | 378 MARKETPLACE DR STE 5 | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376042361 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232820751 | ||||||||
| FaxNumber: | 4232821577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/26/2006 | ||||||||
| LastUpdateDate: | 06/05/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APN07931 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 1194781203 | 05 | VA | MEDICAID | P00435223 | 01 | TN | RAILROAD MEDICARE | OTHER | Q003282 | 05 | TN | MEDICAID |