MEDICARE: ERINN LYNN BASISTA DNP, APRN, FNP-C

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	3015050	KY

General Provider Information

NPI Number	:	1457954471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERINN LYNN BASISTA DNP, APRN, FNP-C

Provider Business Mailing Address
First Line	:	1719 NASHVILLE ST
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-7804
Country	:	US
Telephone Number	:	270-726-9576
Fax Number	:

Provider Business Practice Location Address
First Line	:	1719 NASHVILLE ST STE C
Second Line	:
City	:	RUSSELLVILLE
State	:	KY
Zip	:	42276-7804
Country	:	US
Telephone Number	:	270-726-7664
Fax Number	:

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

Provider Enumeration Date	:	11/20/2020
Last Update Date	:	06/14/2024

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