Provider Demographics
NPI:1548915531
Name:WOODWARD, BAILEY ADAMS (PA-C)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ADAMS
Last Name:WOODWARD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3966 HIGHWAY 80
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-6910
Mailing Address - Country:US
Mailing Address - Phone:318-706-9528
Mailing Address - Fax:
Practice Address - Street 1:117 ELLINGTON DR
Practice Address - Street 2:
Practice Address - City:RAYVILLE
Practice Address - State:LA
Practice Address - Zip Code:71269-3632
Practice Address - Country:US
Practice Address - Phone:318-728-0281
Practice Address - Fax:318-728-0282
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-17
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA330005363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty