Healthcare Provider Details

I. General information

NPI: 1497509210
Provider Name (Legal Business Name): JACOB BASINGER CPNP-PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2024
Last Update Date: 08/17/2025
Certification Date: 08/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7777 YANKEE RD
LIBERTY TOWNSHIP OH
45044-3500
US

IV. Provider business mailing address

3333 BURNET AVE
CINCINNATI OH
45229-3026
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-2866
  • Fax:
Mailing address:
  • Phone: 513-636-4200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.0037864
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN.518835
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: