Provider Demographics
NPI:1114052255
Name:BARWICK, DALE SCURRY (ANP)
Entity Type:Individual
Prefix:MRS
First Name:DALE
Middle Name:SCURRY
Last Name:BARWICK
Suffix:
Gender:F
Credentials:ANP
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 69
Mailing Address - Street 2:
Mailing Address - City:SUMMERTON
Mailing Address - State:SC
Mailing Address - Zip Code:29148
Mailing Address - Country:US
Mailing Address - Phone:803-488-8888
Mailing Address - Fax:803-488-0111
Practice Address - Street 1:123 MAIN ST
Practice Address - Street 2:PO BOX 69
Practice Address - City:SUMMERTON
Practice Address - State:SC
Practice Address - Zip Code:29148
Practice Address - Country:US
Practice Address - Phone:803-488-8888
Practice Address - Fax:803-488-0111
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2018-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN174363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP7622Medicaid