Active NPI
Kristina L Bailey, LPE
- Specialist
- Fayetteville, AR
National Provider Identifier
1003192196
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- 11-10E
- Practice address
- 1 W Sunbridge Dr
Fayetteville, AR 72703-1825 - Phone
- (479) 443-5575
- Fax
- (479) 443-9554
- NPI assigned
- Nov 2, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | 11-10E | AR | Primary |
Addresses
Primary practice location
1 W Sunbridge Dr
Fayetteville, AR 72703-1825
Mailing address
1 W Sunbridge Dr
Fayetteville, AR 72703-1825
Phone (479) 443-5575
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11-10E | AR | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Susan L Shackelford, PHD & Associates, PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Clinical Psychologist
- Fayetteville, AR
- NPI 1205976099
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320192000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320192000000",
"number": "1003192196",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 W SUNBRIDGE DR",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031825",
"telephone_number": "479-443-5575",
"fax_number": "479-443-9554"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 W SUNBRIDGE DR",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727031825",
"telephone_number": "479-443-5575",
"fax_number": "479-443-9554"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BAILEY",
"first_name": "KRISTINA",
"middle_name": "L",
"credential": "LPE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-11-02",
"last_updated": "2011-11-02",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "AR",
"license": "11-10E",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.