Provider Demographics
NPI:1740739366
Name:BASTON, NICHOLAS (DNP, APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:
Last Name:BASTON
Suffix:
Gender:M
Credentials:DNP, APRN, PMHNP
Other - Prefix:
Other - First Name:NICHOLAS
Other - Middle Name:
Other - Last Name:BAGGETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 EASTON OVAL STE 115
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6036
Mailing Address - Country:US
Mailing Address - Phone:216-468-5000
Mailing Address - Fax:801-704-9741
Practice Address - Street 1:2 EASTON OVAL STE 115
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6036
Practice Address - Country:US
Practice Address - Phone:216-468-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10687736-4405363LP0808X
OHAPRN.CNP.019771364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT10687736-4405OtherDOPL
OHAPRN.CNP.019771OtherOHIO BOARD OF NURSING
OHRN.410886OtherBOARD OF NURSING