Provider Demographics
NPI:1619582459
Name:BASS, KATIE MECHELE (APRN)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MECHELE
Last Name:BASS
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 1:6301 MOUNTAIN VISTA ST STE 209
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89014-2364
Mailing Address - Country:US
Mailing Address - Phone:702-703-1202
Mailing Address - Fax:
Practice Address - Street 1:6301 MOUNTAIN VISTA ST STE 209
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-2364
Practice Address - Country:US
Practice Address - Phone:702-703-1202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVCNP836130363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily