MEDICARE: RICHARD D BASHAM ARNP

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	3007397	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	12436388	OTHER	KY	CAQH

General Provider Information

NPI Number	:	1588921738
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RICHARD D BASHAM ARNP

Provider Business Mailing Address
First Line	:	112 CEDAR RIDGE LN
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-8002
Country	:	US
Telephone Number	:	270-971-1388
Fax Number	:	270-297-7066

Provider Business Practice Location Address
First Line	:	332 S MAIN ST
Second Line	:
City	:	LEITCHFIELD
State	:	KY
Zip	:	42754-1428
Country	:	US
Telephone Number	:	270-971-1388
Fax Number	:	270-297-7066

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

Provider Enumeration Date	:	04/12/2012
Last Update Date	:	04/11/2024

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