MEDICARE: CATHERINE COTTLE BASMA

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	163W00000X	Registered Nurse	1087022	TX
2	163WP2201X	Ambulatory Care Registered Nurse	793526	TX
3	363LF0000X	Family Nurse Practitioner	1087022	TX

General Provider Information

NPI Number	:	1407428907
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE COTTLE BASMA

Provider Business Mailing Address
First Line	:	7020 DEER RIDGE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4714
Country	:	US
Telephone Number	:	903-360-1064
Fax Number	:

Provider Business Practice Location Address
First Line	:	7020 DEER RIDGE DR
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76137-4714
Country	:	US
Telephone Number	:	903-360-1064
Fax Number	:

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

Provider Enumeration Date	:	07/14/2021
Last Update Date	:	05/10/2023

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Directions to “ CATHERINE COTTLE BASMA ” Practice Location

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