Basic Information
| Provider Information | |||||||||
| NPI: | 1639207764 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURNETTE-BAILEY | ||||||||
| FirstName: | VICKI | ||||||||
| MiddleName: | ELAINE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 224 WILDWOOD DR | ||||||||
| Address2: | |||||||||
| City: | HOPKINSVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 422405528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319207345 | ||||||||
| FaxNumber: | 9319207332 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 GREENWOOD AVE | ||||||||
| Address2: | |||||||||
| City: | CLARKSVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370404068 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9319207345 | ||||||||
| FaxNumber: | 9319207345 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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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 | 171M00000X | Y | Other Service Providers | Case Manager/Care Coordinator |
No ID Information.