Provider Demographics
NPI:1366492100
Name:BASKETT, JOANNA (PA)
Entity Type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:
Last Name:BASKETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1056 S 88TH ST
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80027-9460
Mailing Address - Country:US
Mailing Address - Phone:303-442-6647
Mailing Address - Fax:303-442-2696
Practice Address - Street 1:1056 S 88TH ST
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:CO
Practice Address - Zip Code:80027-9460
Practice Address - Country:US
Practice Address - Phone:303-442-6647
Practice Address - Fax:303-442-2696
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2022-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1522363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1522OtherCO BOARD MEDICAL EXAMINOR
Q51095Medicare UPIN
CO802963Medicare ID - Type Unspecified