Basic Information
| Provider Information | |||||||||
| NPI: | 1720750235 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROY | ||||||||
| FirstName: | BAILEY | ||||||||
| MiddleName: | JEANNE | ||||||||
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| Credential: | PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 3RD ST | ||||||||
| Address2: | |||||||||
| City: | HARWICH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 02645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5085232103 | ||||||||
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| Practice Location | |||||||||
| Address1: | 40 DAVIS STRAITS | ||||||||
| Address2: | |||||||||
| City: | FALMOUTH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 025403906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7742553010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2021 | ||||||||
| LastUpdateDate: | 02/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 110178427A | 01 | MA | MASSHEALTH | OTHER |