KEITH SAMUEL BASS Advanced Practice Nurse License verification

Business Entity

ACTIVE

License Type

Advanced Practice Nurse

Description

FULL PRACTICE AUTHORITY APRN CONTROL SUB

License Number

37*****22

License Status

ACTIVE

Business

First Name

KEITH

Middle

SAMUEL

Last Name

BASS

Business Name

KEITH SAMUEL BASS

Original Issue Date

12/11/2023

Effective Date

05/04/2024

Expiration Date

05/31/2026

City

ANNA

State

Zip

62906

Ever Disciplined

LastModifiedDate

03/02/2026