Provider Demographics
NPI:1104282565
Name:BAILEY, CHRISTOPHER KIRK (APRN-FNP)
Entity type:Individual
Prefix:MR
First Name:CHRISTOPHER
Middle Name:KIRK
Last Name:BAILEY
Suffix:
Gender:M
Credentials:APRN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 846098
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-6098
Mailing Address - Country:US
Mailing Address - Phone:903-324-6400
Mailing Address - Fax:
Practice Address - Street 1:1718 S HENDERSON BLVD
Practice Address - Street 2:
Practice Address - City:KILGORE
Practice Address - State:TX
Practice Address - Zip Code:75662-3544
Practice Address - Country:US
Practice Address - Phone:903-983-2110
Practice Address - Fax:903-984-3783
Is Sole Proprietor?:No
Enumeration Date:2016-01-14
Last Update Date:2017-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129870363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8GS940OtherBCBS
TX75-2616977-017OtherTRICARE
TX358175301Medicaid
TXP01658344OtherRAIL ROAD MEDICARE
TX75-2616977-017OtherTRICARE