Provider Demographics
NPI:1891783056
Name:BASNIGHT, JEAN (DO)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:BASNIGHT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:TSCHUSCHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:110 STAFFORDSHIRE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-8441
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1224 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532
Practice Address - Country:US
Practice Address - Phone:252-447-7474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2018-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2007-019592084A0401X
NC200701959207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX139638419Medicaid
TX8P5517OtherBCBS PROV. NO.
TXP00179366Medicare PIN
TX8C6113Medicare PIN
TX8P5517OtherBCBS PROV. NO.