Provider Demographics
NPI:1457628539
Name:BASSETT, ALBERT ROBERT (PA CERTIFIED)
Entity Type:Individual
Prefix:
First Name:ALBERT
Middle Name:ROBERT
Last Name:BASSETT
Suffix:
Gender:M
Credentials:PA CERTIFIED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7265 NIGHTSTALKER WAY
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5151
Mailing Address - Country:US
Mailing Address - Phone:270-798-3969
Mailing Address - Fax:
Practice Address - Street 1:7265 NIGHTSTALKER WAY
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5151
Practice Address - Country:US
Practice Address - Phone:270-798-3969
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2022-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
IL1097188363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical