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General NPI Number Information
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NPI Number | 1487718938
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Entity Type | Individual
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Provider Name | BETHANY RACHEL BASNETT NP
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Gender | Female
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Dates
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Enumeration Date | 12/20/2006
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 400 E STATESVILLE AVE STE 200
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City | MOORESVILLE
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State | NC
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Zip | 28115-2588
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Country | US
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Telephone | 704-360-8486
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Fax | 704-230-4674
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Provider Business Mailing Address
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Address Line | 12123 WILLINGDON RD
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City | HUNTERSVILLE
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State | NC
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Zip | 28078-5654
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Country | US
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Telephone | 704-591-6934
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Fax | 704-948-7060
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 005002292
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 5002292
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License Number State | NC
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