Provider Demographics
NPI:1396089199
Name:CLEMENTS-BAILEY, MARY JANE (APRN, BC-ANP/GNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JANE
Last Name:CLEMENTS-BAILEY
Suffix:
Gender:F
Credentials:APRN, BC-ANP/GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 E KELLOGG
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218
Mailing Address - Country:US
Mailing Address - Phone:316-685-2221
Mailing Address - Fax:316-239-2749
Practice Address - Street 1:5500 E KELLOGG
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218
Practice Address - Country:US
Practice Address - Phone:316-685-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-16
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75696-112363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health