Provider Demographics
NPI:1891188702
Name:BASHAM, TIFFANY S (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:S
Last Name:BASHAM
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 JULIANNA CT
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-7936
Mailing Address - Country:US
Mailing Address - Phone:270-900-4988
Mailing Address - Fax:270-900-4985
Practice Address - Street 1:1106 JULIANNA CT
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7936
Practice Address - Country:US
Practice Address - Phone:270-900-4988
Practice Address - Fax:270-900-4985
Is Sole Proprietor?:No
Enumeration Date:2015-03-17
Last Update Date:2025-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000019657363LF0000X
CA95015563363LF0000X
KY3011255363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily