Provider Demographics
NPI:1548081169
Name:SIMS, BAILEY NOEL
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:NOEL
Last Name:SIMS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 TRAIL LOOP DR UNIT 205
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4074
Mailing Address - Country:US
Mailing Address - Phone:270-933-8244
Mailing Address - Fax:
Practice Address - Street 1:260 TRAIL LOOP DR UNIT 205
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-4074
Practice Address - Country:US
Practice Address - Phone:270-933-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-17
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4029252363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily