Provider Demographics
NPI:1316915978
Name:BROSSMAN BASS, KAREN R (NP-C, APRN-C)
Entity type:Individual
Prefix:MS
First Name:KAREN
Middle Name:R
Last Name:BROSSMAN BASS
Suffix:
Gender:F
Credentials:NP-C, APRN-C
Other - Prefix:MS
Other - First Name:KAREN
Other - Middle Name:R
Other - Last Name:BROSSMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C, APRN-C
Mailing Address - Street 1:PO BOX 23229
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42304-3229
Mailing Address - Country:US
Mailing Address - Phone:270-688-1330
Mailing Address - Fax:270-688-1338
Practice Address - Street 1:8599 HIGH POINTE DR
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630
Practice Address - Country:US
Practice Address - Phone:812-842-0370
Practice Address - Fax:812-842-0683
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002104A363LF0000X, 363L00000X
KY3006301363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200807870Medicaid
KY7100046440Medicaid
IN200807870Medicaid
KY33978002Medicare PIN