Individual ProviderKristy BassNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address1278 N Lafayette Dr, Sumter, SC 29150-2964(803) 774-4500PECOS EnrollmentBased on the most recent information from CMS, provider Kristy Bass is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:14 PM.Profile DetailsProvider ID1184905283Provider TypeIndividualFull NameBass, KristyCredentialARNPGenderFemaleSole ProprietorNoEnumeration Date9/1/2011Last Updated5/18/2020Contact InformationPractice LocationPractice Address1278 N Lafayette Dr, Sumter, SC 29150-2964Phone(803) 774-4500Fax(803) 774-4626Mailing LocationMailing Address1278 N Lafayette Dr, Sumter, SC 29150-2964Phone(803) 774-4500Fax(803) 774-4626Provider TaxonomiesCodeDescriptionLicenseCode363LF0000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense18516South CarolinaCode363LF0000XDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicenseAP4072ArizonaProvider IdentifiersIDDescriptionIssuerIDNP2747DescriptionMedicaidIssuerUnlistedSouth Carolina