Provider Demographics
NPI:1922653005
Name:BAILEY, MARY (RD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4410 ARAPAHOE AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80303-1135
Mailing Address - Country:US
Mailing Address - Phone:720-358-4343
Mailing Address - Fax:720-306-4644
Practice Address - Street 1:4410 ARAPAHOE AVE STE 110
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80303-1135
Practice Address - Country:US
Practice Address - Phone:720-358-4343
Practice Address - Fax:720-306-4644
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-06
Last Update Date:2025-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORLD-D-10195179133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty