Provider Demographics
NPI:1124678701
Name:BAILEY, TYWAHNEIKAI LASHAE (CERT HAIR LOSS SPEC)
Entity type:Individual
Prefix:
First Name:TYWAHNEIKAI
Middle Name:LASHAE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CERT HAIR LOSS SPEC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:673 KNOX BLVD STE C
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-1568
Mailing Address - Country:US
Mailing Address - Phone:270-351-4762
Mailing Address - Fax:
Practice Address - Street 1:673 KNOX BLVD STE C
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-1568
Practice Address - Country:US
Practice Address - Phone:270-351-4762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management