Jetaun Bailey
Individual provider Active NPI Counselor · Fairfield, AL
NPI 1477039352 · NPPES record last updated Jul 13, 2018
Key facts
- NPI
- 1477039352
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Counselor 101Y00000X
- License
- 2223 (AL)
- Practice address
- 1012 Hillandale Dr
Fairfield, AL 35064-1526 - Phone
- (205) 542-7960
- NPI assigned
- Jul 13, 2018
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2223 | AL | MD | Counselor |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor |
101Y00000X | 2223 | AL | Yes |
Addresses
Primary practice location
1012 Hillandale Dr
Fairfield, AL 35064-1526
Mailing address
1012 Hillandale Dr
Fairfield, AL 35064-1526
Phone (205) 542-7960
Other providers in Fairfield, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.