Individual
NICHOLAS BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
650 JOEL DR, FORT CAMPBELL, KY 42223-5318
(270) 412-5122
(270) 412-5168
Mailing address
625 N RIVERSIDE DR, CLARKSVILLE, TN 37040-3127
(931) 542-9420
(931) 542-9422
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA0000002721
TN
363AS0400X
Surgical Physician Assistant
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Other
Enumeration date
02/12/2014
Last updated
04/25/2019
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