MEDICARE: LINDA JO BASDEN ANP

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	363L00000X	Nurse Practitioner	5004894	NC
2	363LA2200X	Adult Health Nurse Practitioner	5004894	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184925745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA JO BASDEN ANP

Provider Business Mailing Address
First Line	:	1721 ENON RD
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-9314
Country	:	US
Telephone Number	:	828-754-0101
Fax Number	:	828-757-0402

Provider Business Practice Location Address
First Line	:	1721 ENON RD
Second Line	:
City	:	VALDESE
State	:	NC
Zip	:	28690-9314
Country	:	US
Telephone Number	:	828-879-1601
Fax Number	:	828-874-1403

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

Provider Enumeration Date	:	11/12/2010
Last Update Date	:	05/06/2021

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Directions to “ LINDA JO BASDEN ANP” Practice Location

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