1508111055 NPI number — MRS. JESSICA LEIGH MCGEE BASSETT RD

Table of content: MRS. JESSICA LEIGH MCGEE BASSETT RD (NPI 1508111055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508111055 NPI number — MRS. JESSICA LEIGH MCGEE BASSETT RD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCGEE BASSETT
Provider First Name:
JESSICA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCGEE
Provider Other First Name:
JESSICA
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508111055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/20/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

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

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
50 ACADEMY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYSON CITY
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28713-7636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-735-6340
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/20/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 133N00000X , with the licence number:  1017272 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133NN1002X , with the licence number: 1017272 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: 1017272 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)