Provider Demographics
NPI:1861779332
Name:BAILEY, KATHERINE ELAINE (CPNP)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELAINE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CPNP
Mailing Address - Street 1:13821 VILLAGE MILL DR STE A
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23114-4314
Mailing Address - Country:US
Mailing Address - Phone:804-794-2821
Mailing Address - Fax:
Practice Address - Street 1:13821 VILLAGE MILL DR STE A
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23114-4314
Practice Address - Country:US
Practice Address - Phone:804-794-2821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169662363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics