Individual
DOROTHY KEBASO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2525 COURT DR, GASTONIA, NC 28054-2140
(704) 834-2000
Mailing address
2525 COURT DR, GASTONIA, NC 28054-2140
(704) 834-2000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
265899
NC
363L00000X
Nurse Practitioner
Primary
5013813
NC
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
5013813
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1730501214
—
NC
Enumeration date
01/17/2014
Last updated
02/25/2021
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