Provider Demographics
NPI:1528724861
Name:BAILEY, SHARITA
Entity type:Individual
Prefix:MS
First Name:SHARITA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1616 JUDSON RD STE 5A
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-3653
Mailing Address - Country:US
Mailing Address - Phone:430-215-6048
Mailing Address - Fax:903-470-7275
Practice Address - Street 1:1616 JUDSON RD STE 5A
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75601-3653
Practice Address - Country:US
Practice Address - Phone:430-215-6048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-11
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246RM2200X, 247200000X
TX246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other