Individual
BAYLEN CLINT BASTIBLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6551 HARRIS PKWY, SUITE 250, FORT WORTH, TX 76132-6103
(817) 263-6116
(817) 263-6117
Mailing address
PO BOX 100189, FORT WORTH, TX 76185-0189
(817) 731-0230
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA04507
TX
Other
Enumeration date
06/05/2006
Last updated
05/07/2019
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