Provider Demographics
NPI:1194023127
Name:BASSETT, PAMELA JEAN (RD)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:BASSETT
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 STONEGATE CT
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-5467
Mailing Address - Country:US
Mailing Address - Phone:225-802-8062
Mailing Address - Fax:225-275-4789
Practice Address - Street 1:5266 COMMERCE ST
Practice Address - Street 2:
Practice Address - City:SAINT FRANCISVILLE
Practice Address - State:LA
Practice Address - Zip Code:70775-4409
Practice Address - Country:US
Practice Address - Phone:225-635-3811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA494133V00000X
TN2011133V00000X
MSD1015133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered