Provider Demographics
NPI:1821397282
Name:BASKETTE, BARRY (BARRY BASKETTE)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:BASKETTE
Suffix:
Gender:M
Credentials:BARRY BASKETTE
Other - Prefix:
Other - First Name:BARRY
Other - Middle Name:
Other - Last Name:BASKETTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BARRY BASKETTE
Mailing Address - Street 1:2965 S JONES BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5606
Mailing Address - Country:US
Mailing Address - Phone:702-733-8098
Mailing Address - Fax:
Practice Address - Street 1:2965 S JONES BLVD STE D
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5606
Practice Address - Country:US
Practice Address - Phone:702-733-8098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker