Basham, Dallas Scott
Basham, Dallas Scott is an individual health care provider with primary practice located at 350 Thomas More Pkwy Suite 160, Crestview Hills KY 41017-5465. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Acute Care, Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner, Nursing Service Providers / Registered Nurse. Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner is his primary health care specialty. Basham, Dallas Scott can be contacted via phone (513) 221-1100.Contact Information
Primary practice address
350 Thomas More Pkwy Suite 160
Crestview Hills KY 41017-5465
Phone: (513) 221-1100
Fax: (513) 569-5297
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | COA.06624-NP | Ohio |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | COA.06624-NP | Ohio |
| Nursing Service Providers / Registered Nurse | 163W00000X | RN.178465-1 | Ohio |
| Physician Assistants & Advanced Practice Nursing Providers / Nurse Practitioner | 363L00000X | 3003742 | Kentucky |
| Physician Assistants & Advanced Practice Nursing Providers / Acute Care | 363LA2100X | 3003742 | Kentucky |
| Nursing Service Providers / Registered Nurse | 163W00000X | 1097793 | Kentucky |
Profile Details
| NPI number | 1194758029 |
|---|---|
| LBN Legal business name | Basham, Dallas Scott |
| Credentials | Nurse Practitioner (NP) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jul 7th, 2006 |
| Last updated | Mar 21st, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1194758029 | NPPES |
| Ohio | MEDICAID | 2328734 |
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