Kenya Demeta Bass, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

103419 Issued in NC

Practice address

1905 Skibo Rd Ste 100
Fayetteville, NC 28314-0261

Phone

(910) 864-4357

Fax

(910) 221-0099

NPI assigned

Nov 1, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Rapha Health System Inc

  dba Rapha Medical Clinic PA

  • Internal Medicine Physician
  • Fayetteville, NC
  • NPI 1275510695
  Medicare reassignment
• Accu Reference Medical Lab, LLC

  • Clinical Medical Laboratory
  • Linden, NJ
  • NPI 1225110497
  NPD
• Ravenhill Dermatology Medical Clinic, P.C.

  • Dermatology Physician
  • Fayetteville, NC
  • NPI 1962519462
  NPD (past)
• Sechoir Blow Dry Bar, LLC

  • Dermatology Physician
  • Vienna, VA
  • NPI 1437803947
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162339200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1942387485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 SKIBO RD STE 100",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283140261",
            "telephone_number": "910-864-4357",
            "fax_number": "910-221-0099"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 SKIBO RD STE 100",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283140261",
            "telephone_number": "910-864-4357",
            "fax_number": "910-221-0099"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BASS",
        "first_name": "KENYA",
        "middle_name": "DEMETA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-01",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "103419",
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NC",
            "license": "103419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1942387485",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Anja Basilici
• Christina Baskerville
• Kaitlyn Aubrey Basnett, PHARMD
• Ebrenyka Basnight
• Amanda Bass
• Maryia Bass
• Michael Joseph Bass, DO
• Towanaka Yvette Bass
• Vanessa Bass
• Arash Thomas Bassiri, DDS

• Medical Physician Assistant in Fayetteville, NC
• Providers in Fayetteville, NC by specialty
• Medical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.