Basic Information
| Provider Information | |||||||||
| NPI: | 1821683558 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 ATWELL RD | ||||||||
| Address2: | |||||||||
| City: | COOPERSTOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 133261394 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6075473480 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 136 PARKWAY DR | ||||||||
| Address2: | |||||||||
| City: | COBLESKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 120435150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5186254434 | ||||||||
| FaxNumber: | 5182343415 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/04/2021 | ||||||||
| LastUpdateDate: | 07/21/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/21/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0200X | 779123 | NY | N | Nursing Service Providers | Registered Nurse | Oncology | 363LF0000X | 347691 | NY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.