MEDICARE: MR. TABE BESONG NP

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	5023557	NC
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	PMH11250006	NC

General Provider Information

NPI Number	:	1952271991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. TABE BESONG NP

Provider Business Mailing Address
First Line	:	160 KIMEL FOREST DR STE 100
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6084
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:	336-883-0867

Provider Business Practice Location Address
First Line	:	160 KIMEL FOREST DR STE 100
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27103-6084
Country	:	US
Telephone Number	:	336-883-0029
Fax Number	:	336-883-0867

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

Provider Enumeration Date	:	11/05/2025
Last Update Date	:	06/09/2026

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