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Individual

DALLAS SCOTT BASHAM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
350 THOMAS MORE PKWY, SUITE 160, CRESTVIEW HILLS, KY 41017-5465
(513) 221-1100
(513) 569-5297
Mailing address
PO BOX 643398, CINCINNATI, OH 45264-3398
(513) 221-1100
(513) 569-5297

Taxonomy

Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
1097793
KY
163W00000X
Registered Nurse
RN.178465-1
OH
363L00000X
Nurse Practitioner
Primary
3003742
KY
363L00000X
Nurse Practitioner
COA.06624-NP
OH
363LA2100X
Acute Care Nurse Practitioner
3003742
KY
363LA2100X
Acute Care Nurse Practitioner
COA.06624-NP
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2328734
OH
Enumeration date
07/07/2006
Last updated
03/21/2016
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