Provider Demographics
NPI:1699729954
Name:BAILEY, MEGAN A (PAC)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 CALLAHAN DRIVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BREMERTON
Mailing Address - State:WA
Mailing Address - Zip Code:98310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:840 CALLAHAN DRIVE
Practice Address - Street 2:SUITE A
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98310
Practice Address - Country:US
Practice Address - Phone:360-479-0349
Practice Address - Fax:360-479-0065
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004799363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8418477Medicaid
WAP00227848OtherRAILRAOD MEDICARE
7530BAOtherREGENCE BLUE SHIELD
7530BAOtherREGENCE BLUE SHIELD
WA8418477Medicaid