| Doctor Name: | STACEY BASKERVILLE |
| NPI Number: | 1417099565 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 139905 |
| Business Practice Address: | 300 Silverleaf Rd Apt 1201 Sweeny, TX - 774801839 |
| Business Phone Number: | 9794824637 |
| Business Fax Number: | |
| Mailing Address: | 300 Silverleaf Rd Apt 1201, SWEENY |
| State: | TX |
| Postal Code: | 774801839 |
| Phone Number: | 9794824637 |
| Fax Number: | |
| NPI Enumeration Date: | 02/13/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 146M00000X |
| License Number: | 139905 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Emergency Medical Service Providers |
| Taxonomy Classification: | Emergency Medical Technician, Intermediate |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An Intermediate EMT is an individual trained and certified to perform intermediate life support treatment in medical emergencies based on individual state boards. |