Provider Demographics
NPI:1962126987
Name:BAILEY, KELSEY RAQUAEL
Entity type:Individual
Prefix:
First Name:KELSEY
Middle Name:RAQUAEL
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 1:7400 NW 24TH ST
Mailing Address - Street 2:
Mailing Address - City:MARGATE
Mailing Address - State:FL
Mailing Address - Zip Code:33063-8160
Mailing Address - Country:US
Mailing Address - Phone:954-798-6290
Mailing Address - Fax:
Practice Address - Street 1:7400 NW 24TH ST
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33063-8160
Practice Address - Country:US
Practice Address - Phone:954-798-6290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health