Provider Demographics
NPI:1326583493
Name:BASCH, KATIE E (CRNP)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:E
Last Name:BASCH
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1938 AL HIGHWAY 157 STE 101
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35058-1819
Mailing Address - Country:US
Mailing Address - Phone:256-735-5505
Mailing Address - Fax:256-964-9954
Practice Address - Street 1:1938 AL HIGHWAY 157 STE 101
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35058-1819
Practice Address - Country:US
Practice Address - Phone:256-735-5505
Practice Address - Fax:256-964-9954
Is Sole Proprietor?:No
Enumeration Date:2016-12-28
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR202011502NP-PP363A00000X, 363A00000X
AL1-142277363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily