Doctor Name: | SAMUEL B BAYLESS |
NPI Number: | 1952674194 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | FNP |
License Number: | 16500 |
Business Practice Address: | 1861 Main St Sneedville, TN - 378693645 |
Business Phone Number: | 4237332131 |
Business Fax Number: | 4237331055 |
Mailing Address: | Po Box 850, ROGERSVILLE |
State: | TN |
Postal Code: | 378570850 |
Phone Number: | 4237332131 |
Fax Number: | 4237331055 |
NPI Enumeration Date: | 02/20/2012 |
NPI Last Update Date: | 08/22/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 16500 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | TN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |