Provider Demographics
NPI:1093415200
Name:BASHAM, NIKALEY ANNE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:NIKALEY
Middle Name:ANNE
Last Name:BASHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 OLD SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-7309
Mailing Address - Country:US
Mailing Address - Phone:512-557-8814
Mailing Address - Fax:
Practice Address - Street 1:1228 N STATE HIGHWAY 123
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7730
Practice Address - Country:US
Practice Address - Phone:512-392-5556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-06
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1112210363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner