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General NPI Number Information
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NPI Number | 1285360230
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Entity Type | Individual
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Provider Name | SAMANTHA KALYANI BASSETT FNP-C
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Gender | Female
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Dates
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Enumeration Date | 07/30/2022
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 108 ARIZONA ST
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City | BISBEE
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State | AZ
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Zip | 85603-1804
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Country | US
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Telephone | 520-432-3309
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Fax |
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Provider Business Mailing Address
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Address Line | 1205 N F AVE
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City | DOUGLAS
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State | AZ
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Zip | 85607-1920
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Country | US
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Telephone | 520-459-3110
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 274155
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License Number State | AZ
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