Provider Demographics
NPI:1427168855
Name:BAILEY, ANITA (PHD FNP-BC)
Entity type:Individual
Prefix:DR
First Name:ANITA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHD FNP-BC
Other - Prefix:DR
Other - First Name:ANITA
Other - Middle Name:
Other - Last Name:EVANGELISTA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC AHN-BC
Mailing Address - Street 1:140 PINTO RUN LN
Mailing Address - Street 2:
Mailing Address - City:NOEL
Mailing Address - State:MO
Mailing Address - Zip Code:64854-9345
Mailing Address - Country:US
Mailing Address - Phone:417-669-4740
Mailing Address - Fax:
Practice Address - Street 1:181 PINTO RUN LN
Practice Address - Street 2:
Practice Address - City:NOEL
Practice Address - State:MO
Practice Address - Zip Code:64854-9345
Practice Address - Country:US
Practice Address - Phone:417-669-9904
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA003868363LF0000X
MO150717363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO429344609Medicaid
823783283Medicare ID - Type Unspecified
AR312535YXKJMedicare PIN
MOMA1327088Medicare PIN
MO429344609Medicaid