Provider Demographics
NPI:1285988808
Name:BAILEY, KAREN LYNN (PA-C)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:MANTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:4602 MACCORKLE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25304-1848
Mailing Address - Country:US
Mailing Address - Phone:304-205-7535
Mailing Address - Fax:304-205-7536
Practice Address - Street 1:4602 MACCORKLE AVE SE
Practice Address - Street 2:81 LINCOLN PANTHER WAY
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25304-1848
Practice Address - Country:US
Practice Address - Phone:304-205-7535
Practice Address - Fax:304-205-7536
Is Sole Proprietor?:No
Enumeration Date:2012-11-05
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810025370Medicaid
WVWV2472B662Medicare Oscar/Certification
WVWV2472EMedicare Oscar/Certification
WVWV2482CMedicare Oscar/Certification
WVWV2472GMedicare Oscar/Certification
WVWV2472AMedicare Oscar/Certification
WVWV2472DMedicare Oscar/Certification
WVWV2472HMedicare Oscar/Certification
WV3810025370Medicaid
WVWV2472FMedicare Oscar/Certification
WVWV2472B663Medicare Oscar/Certification