Provider Demographics
NPI:1700379757
Name:BASSO, KRISTA J (PA-C)
Entity Type:Individual
Prefix:
First Name:KRISTA
Middle Name:J
Last Name:BASSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:403 BETHEL RD
Mailing Address - Street 2:
Mailing Address - City:SOMERS POINT
Mailing Address - State:NJ
Mailing Address - Zip Code:08244-2108
Mailing Address - Country:US
Mailing Address - Phone:609-927-8746
Mailing Address - Fax:609-601-1406
Practice Address - Street 1:403 BETHEL RD
Practice Address - Street 2:
Practice Address - City:SOMERS POINT
Practice Address - State:NJ
Practice Address - Zip Code:08244-2108
Practice Address - Country:US
Practice Address - Phone:609-927-8746
Practice Address - Fax:609-601-1406
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant