Provider Demographics
NPI:1295810448
Name:BASYE, LISA MARIE (PAC)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:MARIE
Last Name:BASYE
Suffix:
Gender:
Credentials:PAC
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:MARIE
Other - Last Name:LUDWIG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:1900 SPERRY RUN RD
Mailing Address - Street 2:
Mailing Address - City:RIO
Mailing Address - State:WV
Mailing Address - Zip Code:26755
Mailing Address - Country:US
Mailing Address - Phone:304-897-5933
Mailing Address - Fax:
Practice Address - Street 1:17978 STATE RT. 55
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:WV
Practice Address - Zip Code:26801-0097
Practice Address - Country:US
Practice Address - Phone:304-897-5915
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2025-02-25
Deactivation Date:2009-02-05
Deactivation Code:
Reactivation Date:2009-03-09
Provider Licenses
StateLicense IDTaxonomies
WV345363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant