Provider Demographics
NPI:1457954471
Name:BASISTA, ERINN LYNN (DNP, APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:ERINN
Middle Name:LYNN
Last Name:BASISTA
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 NASHVILLE ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42276-7804
Mailing Address - Country:US
Mailing Address - Phone:270-726-9576
Mailing Address - Fax:
Practice Address - Street 1:1719 NASHVILLE ST STE C
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:KY
Practice Address - Zip Code:42276-7804
Practice Address - Country:US
Practice Address - Phone:270-726-7664
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-20
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015050363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily