Provider Demographics
NPI:1093418014
Name:BARB, KACEY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:
Last Name:BARB
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CUMBERLAND ST
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2005
Mailing Address - Country:US
Mailing Address - Phone:240-522-6993
Mailing Address - Fax:
Practice Address - Street 1:12502 WILLOWBROOK RD STE 300
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-6498
Practice Address - Country:US
Practice Address - Phone:240-964-8787
Practice Address - Fax:240-964-8687
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190371363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily