Provider Demographics
NPI:1578564589
Name:BESS, MARY BETH (APRN)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:BESS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 670
Mailing Address - Street 2:
Mailing Address - City:ANAHUAC
Mailing Address - State:TX
Mailing Address - Zip Code:77514-0670
Mailing Address - Country:US
Mailing Address - Phone:409-267-2730
Mailing Address - Fax:409-267-3099
Practice Address - Street 1:102 AIRPORT RD
Practice Address - Street 2:
Practice Address - City:ANAHUAC
Practice Address - State:TX
Practice Address - Zip Code:77514
Practice Address - Country:US
Practice Address - Phone:409-267-2730
Practice Address - Fax:409-267-3099
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX651493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q30876Medicare UPIN
Q30876Medicare UPIN
TX8C9550Medicare ID - Type Unspecified