Individual
MR. DIRK KENNETH BASKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
840 N 4TH E, MOUNTAIN HOME, ID 83647-2166
(208) 587-1850
Mailing address
840 N 4TH E, MOUNTAIN HOME, ID 83647-2166
(208) 587-1850
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA-2374
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500812528
—
OR
Enumeration date
06/16/2022
Last updated
12/23/2022
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