Provider Demographics
NPI:1760473649
Name:BASKETTE, CHARISSA (NP)
Entity Type:Individual
Prefix:MRS
First Name:CHARISSA
Middle Name:
Last Name:BASKETTE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1437 W MORRIS BLVD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-2828
Mailing Address - Country:US
Mailing Address - Phone:865-587-8041
Mailing Address - Fax:
Practice Address - Street 1:120 HOSPITAL DR
Practice Address - Street 2:SUITE 130
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760-5287
Practice Address - Country:US
Practice Address - Phone:865-475-4742
Practice Address - Fax:865-262-0100
Is Sole Proprietor?:No
Enumeration Date:2005-10-31
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3902314Medicaid
TNP99449Medicare UPIN
TN3902314Medicaid