Provider Demographics
NPI:1669041133
Name:BAILEY, KATRINA LYNN (RDN, PA-C)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RDN, PA-C
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RDN, PA-C
Mailing Address - Street 1:PO BOX 10001
Mailing Address - Street 2:PMB 1451
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950
Mailing Address - Country:US
Mailing Address - Phone:670-285-7486
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 10001
Practice Address - Street 2:
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950-8901
Practice Address - Country:US
Practice Address - Phone:670-285-7486
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2025-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86096825133V00000X
WI1185355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO86096825OtherREGISTERED DIETITIAN