Provider Demographics
NPI:1548985856
Name:BASHAM, MCKAYLA ASHTON (APRN)
Entity type:Individual
Prefix:MRS
First Name:MCKAYLA
Middle Name:ASHTON
Last Name:BASHAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MCKAYLA
Other - Middle Name:
Other - Last Name:PHILLIPS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:599 LONE OAK RD
Mailing Address - Street 2:
Mailing Address - City:CECILIA
Mailing Address - State:KY
Mailing Address - Zip Code:42724-7800
Mailing Address - Country:US
Mailing Address - Phone:270-272-3997
Mailing Address - Fax:
Practice Address - Street 1:599 LONE OAK RD
Practice Address - Street 2:
Practice Address - City:CECILIA
Practice Address - State:KY
Practice Address - Zip Code:42724-7800
Practice Address - Country:US
Practice Address - Phone:270-272-3997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018807363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner