Provider Demographics
NPI:1306819248
Name:BAILEY, LORI L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N 12TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OSKALOOSA
Mailing Address - State:IA
Mailing Address - Zip Code:52577-2495
Mailing Address - Country:US
Mailing Address - Phone:641-672-3360
Mailing Address - Fax:641-672-3356
Practice Address - Street 1:410 N 12TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OSKALOOSA
Practice Address - State:IA
Practice Address - Zip Code:52577-2495
Practice Address - Country:US
Practice Address - Phone:641-672-3360
Practice Address - Fax:641-672-3356
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF0703106363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA05609OtherBC/BS PROVIDER NUMBER
IAIA0129OtherJOHN DEERE PROVIDER NUMBE
IA0422105Medicaid
IA05609OtherBC/BS PROVIDER NUMBER
IA0422105Medicaid