Provider Demographics
NPI:1053321125
Name:BAILEY, JENNY L (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:L
Last Name:BAILEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MRS
Other - First Name:JENNY
Other - Middle Name:L
Other - Last Name:SCHNEIDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:PO BOX 100551
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29502-0551
Mailing Address - Country:US
Mailing Address - Phone:843-777-8752
Mailing Address - Fax:843-777-8705
Practice Address - Street 1:555 E CHEVES ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29506-2617
Practice Address - Country:US
Practice Address - Phone:843-777-8752
Practice Address - Fax:843-777-8705
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041293073367500000X
SCAPN 3975367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN 2006Medicaid
SCAN 2006Medicaid
SCQ353491162Medicare PIN