Individual
NYKOL BAILEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
190 E BANNOCK ST, BOISE, ID 83712-6241
(435) 459-4194
Mailing address
210 N SHIRTTAIL WAY, BLANDING, UT 84511-3220
(435) 459-4194
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
70140
ID
367500000X
Certified Registered Nurse Anesthetist
105690
ID
Other
Enumeration date
01/27/2015
Last updated
09/30/2022
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