Provider Demographics
NPI:1821337916
Name:BASS, NATALIE CHRISTINE (PA-C)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:CHRISTINE
Last Name:BASS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:CHRISTINE
Other - Last Name:WILSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:211 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-3579
Mailing Address - Country:US
Mailing Address - Phone:615-355-0100
Mailing Address - Fax:615-355-0684
Practice Address - Street 1:211 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-3579
Practice Address - Country:US
Practice Address - Phone:615-355-0100
Practice Address - Fax:615-355-0684
Is Sole Proprietor?:No
Enumeration Date:2013-02-08
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000002287363A00000X
TN2287363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant