Desiree Dawn Bailey, AGPC-NP
Individual provider Active NPI Nurse Practitioner · Jeffersonville, IN
NPI 1568068633 · NPPES record last updated Jan 30, 2024
Key facts
- NPI
- 1568068633
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 71010575A (IN)
- Practice address
- 1701 Spring St Ste B
Jeffersonville, IN 47130-2930 - Phone
- (812) 284-2273
- NPI assigned
- Dec 4, 2020
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210610001039 | IN | Practitioner - Nurse Practitioner | 9133529399 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 71010575A | IN | MD | Primary Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Cleanslate Medical Group of Indiana LLC | Current |
Accepting new patients |
Locations
4925 S Scatterfield Rd
Anderson, IN 46013
Phone (765) 442-0402
4925 S Scatterfield Rd
#G
Anderson, IN 46013
Phone (765) 442-0402
1725 N Meridian St
Indianapolis, IN 46202
Phone (317) 396-1676
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Primary Care Nurse Practitioner | 363LP2300X | 71010575A | IN | |
| Nurse Practitioner | 363L00000X | 71010575A | IN | Yes |
Addresses
Primary practice location
1701 Spring St Ste B
Jeffersonville, IN 47130-2930
Mailing address
500 Kirts Blvd Ste 100
Troy, MI 48084-4135
Phone (248) 434-6169
Other practice location 1
9001 Wesleyan Rd Ste 100
Indianapolis, IN 46268-1176
Phone (317) 497-5530
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Jeffersonville | Direct |
Other providers in Jeffersonville, IN
- Back in the Game
- Jose Salvilla Bada
- James L Bailen
- Arlydia Denise Bailey
- Debbi Bailey
- Kayla Bailey
- Tanaya Bailey
- Wendell L Bailey
- Jacquelyn Schneider Bainbridge
- Ashley Maureen Baker
All providers in Jeffersonville, IN · Nurse Practitioner in Indiana
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.