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Individual
MRS. LARISSA L BAILEY
Active
Individual
MRS. LARISSA L BAILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4075P
KY
363LF0000X
Family Nurse Practitioner
4075P
KY
363LP2300X
Primary Care Nurse Practitioner
4075P
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37903705
MEDICAID LAB GROUP
KY
01
—
4000501
MEDICARE LAB GROUP
KY
05
—
78010170
—
KY
01
—
CB5773
RR MEDICARE GROUP
KY
Enumeration date
08/09/2005
Last updated
08/16/2010
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