Provider Demographics
NPI:1285604074
Name:BASTIN-MUSE, ALLISON REBECCA (ARNP)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:REBECCA
Last Name:BASTIN-MUSE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2786
Mailing Address - Country:US
Mailing Address - Phone:606-678-8155
Mailing Address - Fax:606-678-7548
Practice Address - Street 1:350 LANGDON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2786
Practice Address - Country:US
Practice Address - Phone:606-678-8155
Practice Address - Fax:606-678-7548
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2009-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2998P363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78002300Medicaid