Individual
BAILEY ELIZABETH QUALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
701 MED TECH PKWY, SUITE 300, JOHNSON CITY, TN 37604-2365
(423) 232-8301
(423) 232-8304
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-0834
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2282
TN
363AS0400X
Surgical Physician Assistant
2282
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215276654
—
VA
01
—
4347188
BCBS
TN
05
—
7100233840
—
KY
05
—
8103214
—
NC
05
—
Q000183
—
TN
Enumeration date
02/05/2013
Last updated
07/25/2013
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