Healthcare Provider Details

I. General information

NPI: 1194152686
Provider Name (Legal Business Name): MORRESA MAELYN BAIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/30/2013
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date: 04/23/2025
Reactivation Date: 05/22/2025

III. Provider practice location address

158 OAK HOLLOW LN
SULPHUR SPRINGS TX
75482-9705
US

IV. Provider business mailing address

158 OAK HOLLOW LN
SULPHUR SPRINGS TX
75482-9705
US

V. Phone/Fax

Practice location:
  • Phone: 903-335-5900
  • Fax: 903-765-7723
Mailing address:
  • Phone: 903-335-5900
  • Fax: 903-765-7723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP123894
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License Number618022
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: