Provider Demographics
NPI:1891037982
Name:BASS, KANDACE KATHLEEN (MD)
Entity type:Individual
Prefix:
First Name:KANDACE
Middle Name:KATHLEEN
Last Name:BASS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KANDANCE
Other - Middle Name:KATHLEEN
Other - Last Name:WALKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:700 1ST AVE S STE B
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:IA
Mailing Address - Zip Code:50009-1968
Mailing Address - Country:US
Mailing Address - Phone:515-967-8887
Mailing Address - Fax:833-913-0981
Practice Address - Street 1:700 1ST AVE S STE B
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:IA
Practice Address - Zip Code:50009-1968
Practice Address - Country:US
Practice Address - Phone:515-967-8887
Practice Address - Fax:833-913-0981
Is Sole Proprietor?:No
Enumeration Date:2013-03-26
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAMD-43493208000000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist