MEDICARE: ANDREA SEANTRICE BAGSBY

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	363LF0000X	Family Nurse Practitioner	95018862	CA

General Provider Information

NPI Number	:	1649939935
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SEANTRICE BAGSBY

Provider Business Mailing Address
First Line	:	6115 RAGUSA LN
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93308-5172
Country	:	US
Telephone Number	:	661-932-4430
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 TRUXTUN AVE
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-0678
Country	:	US
Telephone Number	:	661-632-1540
Fax Number	:

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

Provider Enumeration Date	:	12/14/2021
Last Update Date	:	12/14/2021

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Directions to “ ANDREA SEANTRICE BAGSBY ” Practice Location

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