Individual
MS. KENYA DEMETA BASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1905 SKIBO RD STE 100, FAYETTEVILLE, NC 28314-0261
(910) 864-4357
(910) 221-0099
Mailing address
1905 SKIBO RD STE 100, FAYETTEVILLE, NC 28314-0261
(910) 864-4357
(910) 221-0099
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
103419
NC
363AM0700X
Medical Physician Assistant
Primary
103419
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1942387485
—
NC
Enumeration date
11/01/2006
Last updated
06/11/2019
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