Basic Information
| Provider Information | |||||||||
| NPI: | 1184297624 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAILEY | ||||||||
| FirstName: | KYLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 947 VILLA DR | ||||||||
| Address2: | |||||||||
| City: | VILLA HILLS | ||||||||
| State: | KY | ||||||||
| PostalCode: | 410173774 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 1859750595 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7675 WELLNESS WAY | ||||||||
| Address2: | |||||||||
| City: | WEST CHESTER | ||||||||
| State: | OH | ||||||||
| PostalCode: | 450692509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134758521 | ||||||||
| FaxNumber: | 5134757480 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/22/2021 | ||||||||
| LastUpdateDate: | 12/07/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0000X | RN.455460 | OH | N | Nursing Service Providers | Registered Nurse | General Practice | 363LA2100X | LE-00039231 | OH | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LA2100X | APRNCNP0030384 | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care |
No ID Information.