Provider Demographics
NPI:1366913170
Name:BAILEY, KELLY ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:KELLY
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 ROOSEVELT ST
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505-5234
Mailing Address - Country:US
Mailing Address - Phone:304-288-4503
Mailing Address - Fax:
Practice Address - Street 1:1414 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-5234
Practice Address - Country:US
Practice Address - Phone:304-288-4503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-06
Last Update Date:2023-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1302103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist