Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Nicholas Basham, PA

Individual provider Surgical Physician Assistant · NPI 1710301684

Nicholas Basham, PA is a Physician Assistant in Fort Campbell, Kentucky. Qualified in 2014, 12 years ago. Practices with Jennie Stuart Medical Center Inc, a 110-clinician group and accepts Medicare assignment. Licensed in Tennessee.

Years since qualifying
12
Licensed in
TN
In the registry since
2014
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

See every abbreviation used in this directory →

Practice location Address checks out

650 Joel Dr
Fort Campbell, KY 42223-5318
Phone: (270) 412-5122
Fax: (270) 412-5168
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence PA0000002721 (TN)
Surgical Physician Assistant Taxonomy 363AS0400X

Record details

NPI number1710301684
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedFebruary 12, 2014
Last updated in NPPESApril 25, 2019
Mailing address625 N Riverside Dr, Clarksville, TN 37040-3127

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2014 (12 years in practice)
Group practice Jennie Stuart Medical Center Inc — 110 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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