Individual
DR. JACQUELINE KHRISTEN BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
140 STONECREST RD, SHELBYVILLE, KY 40065-8142
(502) 633-0094
(502) 633-0033
Mailing address
PO BOX 950248, LOUISVILLE, KY 40295-0248
(502) 253-1035
(502) 253-1037
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
30475
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000204606
ANTHEM
KY
01
—
000000204621
ANTHEM
KY
05
—
64304751
—
KY
Enumeration date
04/14/2006
Last updated
08/21/2014
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