Provider Demographics
NPI:1750153094
Name:BAILEY, JAMES DUSTIN
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:DUSTIN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 S MONROE ST
Mailing Address - Street 2:
Mailing Address - City:ASHDOWN
Mailing Address - State:AR
Mailing Address - Zip Code:71822-3729
Mailing Address - Country:US
Mailing Address - Phone:903-824-6189
Mailing Address - Fax:
Practice Address - Street 1:171 S MONROE ST
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-3729
Practice Address - Country:US
Practice Address - Phone:903-824-6189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-30
Last Update Date:2023-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR101366163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency