Provider Demographics
NPI:1740780741
Name:BASS, KYRA LEALYN (LVN)
Entity Type:Individual
Prefix:MRS
First Name:KYRA
Middle Name:LEALYN
Last Name:BASS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MOCKINGBIRD LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76901-4809
Mailing Address - Country:US
Mailing Address - Phone:806-891-1947
Mailing Address - Fax:
Practice Address - Street 1:275 MOCKINGBIRD LN
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76901-4809
Practice Address - Country:US
Practice Address - Phone:806-891-1947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-15
Last Update Date:2018-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX309890164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse