Provider Demographics
NPI:1740579697
Name:BASS, MARY BETH (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:BETH
Last Name:BASS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 CHILDRENS WAY
Mailing Address - Street 2:SUITE 3103
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37232-2635
Mailing Address - Country:US
Mailing Address - Phone:615-397-4238
Mailing Address - Fax:
Practice Address - Street 1:2200 CHILDRENS WAY
Practice Address - Street 2:SUITE 3103
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37232-2635
Practice Address - Country:US
Practice Address - Phone:615-397-4238
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-31
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1525685Medicaid