Provider Demographics
NPI:1033190582
Name:BARNHART, CAROLYN G (FNPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:G
Last Name:BARNHART
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191050
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83719-1050
Mailing Address - Country:US
Mailing Address - Phone:208-955-6522
Mailing Address - Fax:208-955-6503
Practice Address - Street 1:1375 N HAPPY VALLEY RD
Practice Address - Street 2:
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83687-5280
Practice Address - Country:US
Practice Address - Phone:208-809-2869
Practice Address - Fax:208-809-2868
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP9920363L00000X
IDNP-1427363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0067130Medicaid
CAZZZ28485ZOtherBLUE SHIELD
CAZZZ28485ZOtherBLUE SHIELD