# MRS. LARISSA L BAILEY

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1598766768
- **Gender:** F
- **Credential:** ARNP

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363L00000X | Nurse Practitioner | 4075P | KY | Yes |
| 363LF0000X | Family Nurse Practitioner | 4075P | KY | — |
| 363LP2300X | Primary Care Nurse Practitioner | 4075P | KY | — |

## Other

- **Enumeration date:** 08/09/2005
- **Last updated:** 08/16/2010

## 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 |