Provider Demographics
NPI:1205426681
Name:BASSETT, LINDA D
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:D
Last Name:BASSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 DIXON KING RD
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MS
Mailing Address - Zip Code:39039-8397
Mailing Address - Country:US
Mailing Address - Phone:662-571-2309
Mailing Address - Fax:
Practice Address - Street 1:275 DIXON KING RD
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:MS
Practice Address - Zip Code:39039-8397
Practice Address - Country:US
Practice Address - Phone:662-571-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS913579163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse