Basic Information
| Provider Information | |||||||||
| NPI: | 1417209784 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILES | ||||||||
| FirstName: | KRISTIN | ||||||||
| MiddleName: | GAIL | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 305 CHESTNUT HILL RD | ||||||||
| Address2: | |||||||||
| City: | SUMMERSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 266511856 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046198282 | ||||||||
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| Practice Location | |||||||||
| Address1: | 186 HOSPITAL DR | ||||||||
| Address2: | |||||||||
| City: | GRANTSVILLE | ||||||||
| State: | WV | ||||||||
| PostalCode: | 261477100 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3043549244 | ||||||||
| FaxNumber: | 3043540444 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/10/2012 | ||||||||
| LastUpdateDate: | 10/10/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | F0712319 | WV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.