Individual
JODY LYNN BASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
105 ADAIR ST, BECKLEY, WV 25801-3733
(304) 256-4500
Mailing address
105 ADAIR ST, BECKLEY, WV 25801-3733
(304) 256-4500
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
44106
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3810009008
—
WV
Enumeration date
05/21/2008
Last updated
05/21/2008
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