Provider Demographics
NPI:1124477781
Name:BAILEY SANDERS, BRIDGETTE
Entity type:Individual
Prefix:
First Name:BRIDGETTE
Middle Name:
Last Name:BAILEY SANDERS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10926 QUALITY DR UNIT 38672
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28278-8858
Mailing Address - Country:US
Mailing Address - Phone:704-718-7773
Mailing Address - Fax:
Practice Address - Street 1:2015 AYRSLEY TOWN BLVD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28273-4068
Practice Address - Country:US
Practice Address - Phone:704-469-7477
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-05
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30189363LP0808X
NC5021590363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health