Individual provider Active NPI

Audrey Kathryn Bailey

  • Family Medicine Physician
  • Grenada, MS
National Provider Identifier
1053088922
Registry record updated Aug 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
904839 Issued in MS
Practice address
40 Lark Dr
Grenada, MS 38901-9640
Phone
(166) 280-9245
NPI assigned
Aug 27, 2021
Last updated
Aug 27, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 904839 MS Primary

Addresses

Primary practice location

40 Lark Dr
Grenada, MS 38901-9640

Mailing address

40 Lark Dr
Grenada, MS 38901-9640
Phone (662) 809-2450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211101003152 MS Practitioner - Nurse Practitioner 9133517733 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wound Management Specialists LLCGroup PAC ID 5193056364, 157 clinicians
Healthcare Plus Limited Liability CompanyGroup PAC ID 5698038610, 120 clinicians

Practice addresses (Care Compare)

1190 N State St
Jackson, MS 39202-2413
Phone (769) 243-6141

2781 C T Switzer Sr Dr
Suite 100
Biloxi, MS 39531-4535
Phone (769) 243-6141

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
904839MSMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rapid Track Urgent Care LLC CurrentSince Dec 1, 2025 Accepting new patients
Healthcare Plus Limited Liability Company CurrentSince Jul 18, 2023 Accepting new patients
Wound Management Specialists, LLC Family Medicine CurrentSince Apr 1, 2022 Accepting new patients

Locations

2781 C T Switzer SR Dr
Ste 100
Biloxi, MS 39531
Phone (228) 207-8632

778 Liberty Rd
Flowood, MS 39232
Phone (601) 914-9620

1201 Sunset Dr
Grenada, MS 38901
Phone (662) 222-1070

1190 N State St
Ste 2A
Jackson, MS 39202
Phone (601) 292-4292

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 5

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1630022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1630022400000",
    "number": "1053088922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "40 LARK DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389019640",
            "telephone_number": "662-809-2450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "40 LARK DR",
            "city": "GRENADA",
            "state": "MS",
            "postal_code": "389019640",
            "telephone_number": "166-280-9245"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAILEY",
        "first_name": "AUDREY",
        "middle_name": "KATHRYN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-08-27",
        "last_updated": "2021-08-27",
        "certification_date": "2021-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MS",
            "license": "904839",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Grenada, MS

Sources for this page

Verify at the official NPI Registry.