Provider Demographics
NPI:1194152686
Name:BAIN, MORRESA MAELYN (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MORRESA
Middle Name:MAELYN
Last Name:BAIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 OAK HOLLOW LN
Mailing Address - Street 2:
Mailing Address - City:SULPHUR SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75482-9705
Mailing Address - Country:US
Mailing Address - Phone:903-335-5900
Mailing Address - Fax:903-765-7723
Practice Address - Street 1:600 COLUMBUS AVE
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76701-1310
Practice Address - Country:US
Practice Address - Phone:254-405-4537
Practice Address - Fax:903-405-3455
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-30
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX618022364SF0001X
TXAP123894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX189636706Medicaid
TX1710433743Medicaid