Individual
MR. DERRICK ANDREW BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
166 SPRINGBROOK AVE STE 101, CLAYTON, NC 27520-8520
(919) 550-3430
Mailing address
2000 PERIMETER PARK DR STE 200, MORRISVILLE, NC 27560-8442
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
AT001963
GA
363A00000X
Physician Assistant
Primary
0010-11712
NC
363AS0400X
Surgical Physician Assistant
0010-11712
NC
Other
Enumeration date
12/13/2016
Last updated
12/06/2021
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