Individual provider Active NPI

Bailey Adele Holman, CPNP-PC

  • Pediatric Nurse Practitioner
  • Kansas City, MO
National Provider Identifier
1962094516
Registry record updated Feb 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
2021003901 Issued in MO
Practice address
2401 Gillham Rd
Kansas City, MO 64108-4619
Phone
(816) 234-3000
Fax
(816) 302-9939
NPI assigned
Feb 5, 2021
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 2021003901 MO Primary

Addresses

Primary practice location

2401 Gillham Rd
Kansas City, MO 64108-4619

Mailing address

2401 Gillham Rd
Kansas City, MO 64108-4619
Phone (816) 234-3000

Other names 1

  • Bailey Sestak Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS, MO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20210209001407 KS Practitioner - Nurse Practitioner 0244645083 Reassigns benefits to 1 organization
I20210211003240 MO Practitioner - Nurse Practitioner 0244645083 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
The Children'S Mercy Hospital CurrentSince Feb 8, 2021 Accepting new patients
The Children'S Mercy Hospital Pediatrics CurrentSince Feb 8, 2021 Accepting new patients

Locations

5808 W 110th St
Overland Park, KS 66211
Phone (913) 696-8000

2401 Gillham Rd
Kansas City, MO 64108
Phone (816) 234-3380

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1612483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1612483200000",
    "number": "1962094516",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2401 GILLHAM RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641084619",
            "telephone_number": "816-234-3000",
            "fax_number": "816-302-9939"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2401 GILLHAM RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641084619",
            "telephone_number": "816-234-3000",
            "fax_number": "816-302-9939"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMAN",
        "first_name": "BAILEY",
        "middle_name": "ADELE",
        "name_prefix": "Mrs.",
        "credential": "CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-02-05",
        "last_updated": "2021-02-05",
        "certification_date": "2021-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MO",
            "license": "2021003901",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "BAILEY",
            "last_name": "SESTAK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.