Provider Demographics
NPI:1043858509
Name:BASHAM, KAREN LYNN (CSFA, CST, CRCST)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LYNN
Last Name:BASHAM
Suffix:
Gender:F
Credentials:CSFA, CST, CRCST
Other - Prefix:
Other - First Name:KAREN
Other - Middle Name:LYNN
Other - Last Name:GAINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSFA, CST, CRCST
Mailing Address - Street 1:14141 AZALEA PARK AVE APT C
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70816-1674
Mailing Address - Country:US
Mailing Address - Phone:573-410-2908
Mailing Address - Fax:
Practice Address - Street 1:14141 AZALEA PARK AVE APT C
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70816-1674
Practice Address - Country:US
Practice Address - Phone:573-410-2908
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-16
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
No246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist