Provider Demographics
NPI:1063143329
Name:BAILEY, JOHN ROBERT DEAN (APRN-CNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:ROBERT DEAN
Last Name:BAILEY
Suffix:
Gender:M
Credentials:APRN-CNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 W COLLIN RAYE DR
Mailing Address - Street 2:
Mailing Address - City:DE QUEEN
Mailing Address - State:AR
Mailing Address - Zip Code:71832-2027
Mailing Address - Country:US
Mailing Address - Phone:870-518-0028
Mailing Address - Fax:
Practice Address - Street 1:1021 W COLLIN RAYE DR
Practice Address - Street 2:
Practice Address - City:DE QUEEN
Practice Address - State:AR
Practice Address - Zip Code:71832-2027
Practice Address - Country:US
Practice Address - Phone:870-518-0018
Practice Address - Fax:870-627-3532
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR220804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty