Provider Demographics
NPI:1730848300
Name:BAILEY, CORRINA (PMHNP)
Entity type:Individual
Prefix:
First Name:CORRINA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 N BENTALOU ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-3704
Mailing Address - Country:US
Mailing Address - Phone:443-271-9285
Mailing Address - Fax:888-511-3840
Practice Address - Street 1:1701 N BENTALOU ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-3704
Practice Address - Country:US
Practice Address - Phone:443-271-9285
Practice Address - Fax:888-511-3840
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-10
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149768363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health