MEDICARE: MRS. AMBER BASS MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	224111	NC
2	363L00000X	Nurse Practitioner	5005236	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2335816	OTHER	NC	MEDICARE PTAN, GROUP
2	NC2032A	OTHER	NC	MEDICARE PTAN, INDIVIDUAL

General Provider Information

NPI Number	:	1144508987
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMBER BASS MSN, FNP-C

Provider Business Mailing Address
First Line	:	MEDICAL CENTER BLVD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27157-0001
Country	:	US
Telephone Number	:	336-716-2255
Fax Number	:

Provider Business Practice Location Address
First Line	:	1914 W PARK DR
Second Line	:
City	:	NORTH WILKESBORO
State	:	NC
Zip	:	28659-3563
Country	:	US
Telephone Number	:	336-903-7710
Fax Number	:	336-903-7711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2011
Last Update Date	:	01/19/2024

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Directions to “ MRS. AMBER BASS MSN, FNP-C” Practice Location

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