MEDICARE: CODY LEE BACH FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0994785	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598319642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CODY LEE BACH FNP-BC

Provider Business Mailing Address
First Line	:	PO BOX 92227
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89193-2227
Country	:	US
Telephone Number	:	775-322-4550
Fax Number	:	775-322-4956

Provider Business Practice Location Address
First Line	:	780 E WASHINGTON BLVD
Second Line	:
City	:	CRESCENT CITY
State	:	CA
Zip	:	95531-8397
Country	:	US
Telephone Number	:	775-322-4550
Fax Number	:	775-322-4956

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2019
Last Update Date	:	05/12/2026

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