Individual
MARY KAY BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
855 MONTGOMERY ST, DEPT OF OB/GYN, FORT WORTH, TX 76107-2553
(817) 927-1065
(817) 927-1065
Mailing address
PO BOX 99335, FORT WORTH, TX 76199-0335
Taxonomy
Speciality
Code
Description
License number
State
363LW0102X
Women's Health Nurse Practitioner
Primary
426139
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044360804
—
TX
01
—
8N8816
BCBS
TX
01
—
P00415573
RAILROAD MEDICARE
TX
Enumeration date
10/17/2006
Last updated
09/26/2011
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