Provider Demographics
NPI:1104337849
Name:BAILEY, COURTNEY DIANE
Entity type:Individual
Prefix:
First Name:COURTNEY
Middle Name:DIANE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:COURTNEY
Other - Middle Name:DIANE
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12628 HOOPER RD STE C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70818-3527
Mailing Address - Country:US
Mailing Address - Phone:225-953-8170
Mailing Address - Fax:225-953-8175
Practice Address - Street 1:12628 HOOPER RD STE C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70818-3527
Practice Address - Country:US
Practice Address - Phone:225-953-8170
Practice Address - Fax:225-953-8175
Is Sole Proprietor?:No
Enumeration Date:2017-10-21
Last Update Date:2017-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator