Provider Demographics
NPI:1295462588
Name:HITCHCOCK, BASEMA HABASH (RD)
Entity type:Individual
Prefix:
First Name:BASEMA
Middle Name:HABASH
Last Name:HITCHCOCK
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:BASEMA
Other - Middle Name:SAMIR
Other - Last Name:HABASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD
Mailing Address - Street 1:2195 HARRODSBURG RD STE 125
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-3543
Mailing Address - Country:US
Mailing Address - Phone:859-323-2232
Mailing Address - Fax:859-257-0659
Practice Address - Street 1:2195 HARRODSBURG RD STE 125
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3543
Practice Address - Country:US
Practice Address - Phone:859-323-2232
Practice Address - Fax:859-257-0659
Is Sole Proprietor?:No
Enumeration Date:2022-08-05
Last Update Date:2023-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY275347133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered