Healthcare Provider Details

I. General information

NPI: 1578564589
Provider Name (Legal Business Name): MARY BETH BESS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 01/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 AIRPORT RD
ANAHUAC TX
77514
US

IV. Provider business mailing address

PO BOX 670
ANAHUAC TX
77514-0670
US

V. Phone/Fax

Practice location:
  • Phone: 409-267-2730
  • Fax: 409-267-3099
Mailing address:
  • Phone: 409-267-2730
  • Fax: 409-267-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number651493
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: