Provider Demographics
NPI:1194097444
Name:BASS, ASHLEY CATE (APRN)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:CATE
Last Name:BASS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:CATE
Other - Last Name:BLALOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:367 S. GULPH RD
Mailing Address - Street 2:ATTN: IPM CREDENTIALING
Mailing Address - City:KING OF PRUSSIA
Mailing Address - State:PA
Mailing Address - Zip Code:19406-3121
Mailing Address - Country:US
Mailing Address - Phone:803-641-4874
Mailing Address - Fax:
Practice Address - Street 1:137 MIRACLE DR
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29801-6351
Practice Address - Country:US
Practice Address - Phone:803-641-4874
Practice Address - Fax:803-641-0436
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC23350363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health