Individual
MS. TRACY BASHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
401 E VERMILLION ST, ATHENS, WV 24712-8005
(304) 384-7325
Mailing address
118 12TH STREET EXT, PRINCETON, WV 24740-2352
(304) 431-5168
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
49397NP
WV
Other
Enumeration date
12/13/2016
Last updated
04/19/2018
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