Provider Demographics
NPI:1487718938
Name:BASNETT, BETHANY RACHEL (NP)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:RACHEL
Last Name:BASNETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12123 WILLINGDON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-5654
Mailing Address - Country:US
Mailing Address - Phone:704-591-6934
Mailing Address - Fax:704-948-7060
Practice Address - Street 1:400 E STATESVILLE AVE STE 200
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28115-2588
Practice Address - Country:US
Practice Address - Phone:704-360-8486
Practice Address - Fax:704-230-4674
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005002292363L00000X
NC5002292363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ76992Medicare UPIN
NC2592793Medicare PIN