Healthcare Provider Details

I. General information

NPI: 1952271991
Provider Name (Legal Business Name): TABE BESONG NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2025
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 KIMEL FOREST DR STE 100
WINSTON SALEM NC
27103-6084
US

IV. Provider business mailing address

645 N MAIN ST
HIGH POINT NC
27260-5017
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-0029
  • Fax: 336-883-0867
Mailing address:
  • Phone: 336-883-0029
  • Fax: 336-883-0867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5023557
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberPMH11250006
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: