Individual
SHALA BASKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2379 CYPRESS CIR, CONWAY, SC 29526-8921
(800) 226-8874
Mailing address
3800 S OCEAN DR STE 209, HOLLYWOOD, FL 33019-2915
(800) 226-8874
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
27026
SC
363LF0000X
Family Nurse Practitioner
Primary
27026
SC
Other
Enumeration date
02/06/2023
Last updated
09/24/2024
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