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Contact Information

DALLAS S BASHAM, NP
350 THOMAS MORE PKWY
SUITE 160
CRESTVIEW HILLS, KY41017-5465
 Phone: 513-221-1100
 Fax: 513-569-5297
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Nurse Practitioner

363L00000X 50 Nurse Practitioner
 

Acute Care

363LA2100X 50 Nurse Practitioner
 

Registered Nurse

163W00000X
Indicates primary specialty

NPI Profile & details for DALLAS S BASHAM · (Male)

NPI Number 1194758029
Status Active
Credentials NP (Nurse Practitioner)
Entity Individual
Enumeration date 07/07/2006
Last updated 03/21/2016 - About 10 years ago
Sole proprietor 1 No
Identifiers
  • KY License # 1097793
  • KY License # 3003742
  • OH License # COA.06624-NP
  • OH License # RN.178465-1
  • OH Medicaid 2328734
Hospital affiliation(s)
  • ST ELIZABETH FLORENCE - (Acute Care)
    4900 HOUSTON ROAD
    FLORENCE, KY 41042
  • ST ELIZABETH MEDICAL CENTER NORTH - (Acute Care)
    1 MEDICAL VILLAGE DRIVE
    LAKESIDE PARK, KY 41017
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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