Provider Demographics
NPI:1124688858
Name:BASSETT, MICHELLE (FNP-C)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:BASSETT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 WASHINGTON SQUARE SHOPPING CTR
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63090-5343
Mailing Address - Country:US
Mailing Address - Phone:636-390-1777
Mailing Address - Fax:363-390-1778
Practice Address - Street 1:555 WASHINGTON SQUARE SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:MO
Practice Address - Zip Code:63090-5343
Practice Address - Country:US
Practice Address - Phone:636-390-1777
Practice Address - Fax:363-390-1778
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012003128163W00000X
MO2019024652363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse