Provider Demographics
NPI:1902549769
Name:KANDELAKI, JILL BAILEY (DO)
Entity Type:Individual
Prefix:DR
First Name:JILL
Middle Name:BAILEY
Last Name:KANDELAKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:JILL
Other - Middle Name:KATHLEEN
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:4800 E JOHNSON AVE
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72405-8413
Mailing Address - Country:US
Mailing Address - Phone:870-936-0254
Mailing Address - Fax:
Practice Address - Street 1:4800 E JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72405-8413
Practice Address - Country:US
Practice Address - Phone:870-936-0254
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program