Individual provider · NPI-1

Jared Bashaw

Specialist/Technologist, Athletic Trainer · Kansas City, KS

NPI number1003586132
StatusActive
Last updated in NPPESSep 20, 2021

Details

NPI
1003586132
Entity type
Individual (NPI-1)
Name
Jared Bashaw
Sex
Male
Sole proprietor
Yes
Enumeration date
Sep 20, 2021
Certification date
Sep 20, 2021
Last updated
Sep 20, 2021

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
2255A2300X Specialist/Technologist, Athletic Trainer24-01213KSYes

Practice location

1800 Village West Pkwy
Kansas City, KS 66111-1825

Phone 913-328-5618

Mailing address

13320 Hauser St Apt 3303
Overland Park, KS 66213-2477

Phone 620-218-2855

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