Provider Demographics
NPI:1891037982
Name:BASS, KANDACE KATHLEEN (MD)
Entity Type:Individual
Prefix:
First Name:KANDACE
Middle Name:KATHLEEN
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANDANCE
Other - Middle Name:KATHLEEN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1475
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50305-1475
Mailing Address - Country:US
Mailing Address - Phone:515-961-8448
Mailing Address - Fax:515-643-9100
Practice Address - Street 1:800 E 1ST ST STE 2200
Practice Address - Street 2:
Practice Address - City:ANKENY
Practice Address - State:IA
Practice Address - Zip Code:50021-2077
Practice Address - Country:US
Practice Address - Phone:515-643-9000
Practice Address - Fax:515-643-7509
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2019-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43493208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist