Individual
MS. KRISTEN RUTH BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1811 E BERT KOUNS INDUSTRIAL LOOP STE 400, SHREVEPORT, LA 71105
(318) 212-3810
(318) 212-3815
Mailing address
1202 LOUISIANA AVE, SHREVEPORT, LA 71101-3910
(318) 212-8951
(318) 212-6752
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA.200391
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2153587
—
LA
Enumeration date
10/26/2010
Last updated
06/17/2021
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