MEDICARE: MRS. JESSICA LEIGH MCGEE BASSETT RD

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	133N00000X	Nutritionist	1017272	NC
2	133NN1002X	Nutrition Education Nutritionist	1017272	NC
3	133V00000X	Registered Dietitian	1017272	NC

General Provider Information

NPI Number	:	1508111055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JESSICA LEIGH MCGEE BASSETT RD

Provider Business Mailing Address
First Line	:	937 LOWER STECOAH RD
Second Line	:
City	:	ROBBINSVILLE
State	:	NC
Zip	:	28771-8914
Country	:	US
Telephone Number	:	828-735-6340
Fax Number	:

Provider Business Practice Location Address
First Line	:	50 ACADEMY ST
Second Line	:
City	:	BRYSON CITY
State	:	NC
Zip	:	28713-7636
Country	:	US
Telephone Number	:	828-735-6340
Fax Number	:

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

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	07/20/2012

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