Individual provider Active NPI

Stephen Baley, RN

  • Registered Nurse
  • Jackson, MS
National Provider Identifier
1104074350
Registry record updated Aug 29, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
R760315 Issued in MS
Practice address
1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116
Phone
(601) 362-4471
NPI assigned
Aug 29, 2008
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X R760315 MS Primary

Addresses

Primary practice location

1500 E Woodrow Wilson Ave
Jackson, MS 39216-5116

Mailing address

3793 Coker Rd
Madison, MS 39110-7137
Phone (601) 856-3220

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
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
R760315MSMDRegistered Nurse

NPI Registry JSON

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

{
    "created_epoch": "1219968000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1219968000000",
    "number": "1104074350",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3793 COKER RD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107137",
            "telephone_number": "601-856-3220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 E WOODROW WILSON AVE",
            "city": "JACKSON",
            "state": "MS",
            "postal_code": "392165116",
            "telephone_number": "601-362-4471"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALEY",
        "first_name": "STEPHEN",
        "name_prefix": "Mr.",
        "credential": "RN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-08-29",
        "last_updated": "2008-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MS",
            "license": "R760315",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jackson, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 29, 2008; 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.