Provider Demographics
NPI:1740866375
Name:BASS, JESSIE MARGURIETTE (NP-C)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:MARGURIETTE
Last Name:BASS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:73 SW PARK AVE STE B
Mailing Address - Street 2:
Mailing Address - City:BAXLEY
Mailing Address - State:GA
Mailing Address - Zip Code:31513-2008
Mailing Address - Country:US
Mailing Address - Phone:912-705-8050
Mailing Address - Fax:912-705-8051
Practice Address - Street 1:73 SW PARK AVE STE B
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-2008
Practice Address - Country:US
Practice Address - Phone:912-705-8050
Practice Address - Fax:912-705-8051
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN252752363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily