Provider Demographics
NPI:1841736915
Name:BASSELL, JAMIE (CNP)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:BASSELL
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 299
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-9054
Mailing Address - Country:US
Mailing Address - Phone:575-356-6652
Mailing Address - Fax:575-359-6827
Practice Address - Street 1:42121 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-9054
Practice Address - Country:US
Practice Address - Phone:575-356-6652
Practice Address - Fax:575-359-6827
Is Sole Proprietor?:No
Enumeration Date:2017-01-13
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03149363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily