Provider Demographics
NPI:1154352789
Name:BAILEY, RONALD KEITH (PA C)
Entity type:Individual
Prefix:MR
First Name:RONALD
Middle Name:KEITH
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 E BROAD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4338
Mailing Address - Country:US
Mailing Address - Phone:910-639-6610
Mailing Address - Fax:
Practice Address - Street 1:921 E BROAD AVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4338
Practice Address - Country:US
Practice Address - Phone:910-639-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
NC103712101YA0400X, 363A00000X, 363AS0400X, 363AM0700X
MDC0003059363A00000X
PAMA053489363AS0400X, 363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50079769OtherCAPITAL BLUE CROSS-WMG
PA2065854OtherHIGHMARK BLUE SHIELD
PA130567Medicare PIN