Provider Demographics
NPI:1215276654
Name:QUALLS, BAILEY ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ELIZABETH
Last Name:QUALLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:ELIZABETH
Other - Last Name:OAKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 9150
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42002-9150
Mailing Address - Country:US
Mailing Address - Phone:270-744-9600
Mailing Address - Fax:270-744-0834
Practice Address - Street 1:701 MED TECH PKWY
Practice Address - Street 2:SUITE 300
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2365
Practice Address - Country:US
Practice Address - Phone:423-232-8301
Practice Address - Fax:423-232-8304
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2282363A00000X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1215276654Medicaid
TN4347188OtherBCBS
KY7100233840Medicaid
TNQ000183Medicaid
NC8103214Medicaid
TN4347188OtherBCBS