Bailey Deatherage

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

8224 County Road 604
Alvarado, TX 76009-8642

Phone

(682) 472-2569

NPI assigned

Jun 26, 2022

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1656201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656201600000",
    "number": "1043942444",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8224 COUNTY ROAD 604",
            "city": "ALVARADO",
            "state": "TX",
            "postal_code": "760098642",
            "telephone_number": "682-472-2569"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8224 COUNTY ROAD 604",
            "city": "ALVARADO",
            "state": "TX",
            "postal_code": "760098642",
            "telephone_number": "682-472-2569"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DEATHERAGE",
        "first_name": "BAILEY",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-06-26",
        "last_updated": "2022-06-26",
        "certification_date": "2022-06-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "TX",
            "license": null,
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "TX",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Student in an Organized Health Care Education/Training Program in Alvarado, TX
• Providers in Alvarado, TX by specialty
• Student in an Organized Health Care Education/Training Program in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.