Basic Information
| Provider Information | |||||||||
| NPI: | 1982218301 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | KIMBERLEY | ||||||||
| MiddleName: | MAY | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1703 INNOVATION DR STE 4120 | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174088815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176329263 | ||||||||
| FaxNumber: | 7176467439 | ||||||||
| Practice Location | |||||||||
| Address1: | 1703 INNOVATION DR STE 4120 | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 174088815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7176329263 | ||||||||
| FaxNumber: | 7176467439 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2020 | ||||||||
| LastUpdateDate: | 10/19/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/19/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | R214570 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | SP023658 | PA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.