Jill Keneda Bailey, APRN, BC
Individual provider Active NPI Family Nurse Practitioner · Beaver, WV
NPI 1871785261 · NPPES record last updated Apr 22, 2008
Key facts
- NPI
- 1871785261
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 57720 (WV)
- Practice address
- 993 Ritter Dr
Beaver, WV 25813-9556 - Phone
- (304) 254-9330
- Fax
- (304) 254-9335
- NPI assigned
- Aug 9, 2007
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2006
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Hospice of Southern West Virginia, Inc
Practice addresses (Care Compare)
456 Cranberry Dr
Beckley, WV 25801-8560
Phone (304) 255-6404
Hospital & facility affiliations
- Raleigh General Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- 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 |
|---|---|---|---|---|
| I20071207000536 | WV | Practitioner - Nurse Practitioner | 4688763022 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 57720 | WV | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hospice of Southern West Virginia, Inc | Current |
Accepting new patients | |
| Hospice of Southern WV Dba Palliative Care of Southern West Virginia | Family | Past | Accepting new patients |
Locations
1619 Stanaford Rd
Ste 226
Beckley, WV 25801
456 Cranberry Dr
Beckley, WV 25801
Phone (304) 255-6404
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 57720 | WV | Yes |
Addresses
Primary practice location
993 Ritter Dr
Beaver, WV 25813-9556
Mailing address
993 Ritter Dr
Beaver, WV 25813-9556
Phone (304) 254-9330
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3810009614 | Medicaid | WV |
Other providers in Beaver, WV
- Anderson Chiropractic Center
- Alisha Danyiel Anderson
- Austin Luke Angel
- James W Aurentz
- Back to Health Chiropractic
- Thomas Bailey
- Leisha Banks
- James E Beaver Jr.
- Beckley Treatment Center, LLC
- Beckley Treatment Center, LLC
All providers in Beaver, WV · Family Nurse Practitioner in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 22, 2008. 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).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.