Provider Demographics
NPI:1063415644
Name:WHITTEN-BAILEY, RON (NP-C)
Entity type:Individual
Prefix:
First Name:RON
Middle Name:
Last Name:WHITTEN-BAILEY
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8656 W GAGE BLVD STE 202
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7145
Mailing Address - Country:US
Mailing Address - Phone:509-987-1246
Mailing Address - Fax:509-987-1247
Practice Address - Street 1:8656 W GAGE BLVD STE 202
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7145
Practice Address - Country:US
Practice Address - Phone:509-987-1246
Practice Address - Fax:509-987-1247
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200450156NP363LF0000X
WAAP30006881363LF0000X, 363LF0000X
CA17853363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily