Provider Demographics
NPI:1316307366
Name:BAILEY, TERRICKA LATREASE (RN /APN)
Entity type:Individual
Prefix:MRS
First Name:TERRICKA
Middle Name:LATREASE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN /APN
Other - Prefix:MRS
Other - First Name:TERRICKA
Other - Middle Name:L
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ACNP
Mailing Address - Street 1:2363 LINDA SHORE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHAVEN
Mailing Address - State:MS
Mailing Address - Zip Code:38672-8382
Mailing Address - Country:US
Mailing Address - Phone:601-955-1846
Mailing Address - Fax:
Practice Address - Street 1:4250 BETHEL RD
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-8737
Practice Address - Country:US
Practice Address - Phone:662-932-9440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-03
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS870475363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care