Provider Demographics
NPI:1235547316
Name:BARTON, HENRY DWAYNE (NP)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:DWAYNE
Last Name:BARTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:H.
Other - Middle Name:DWAYNE
Other - Last Name:BARTON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:3180 FAIRVIEW PARK DR
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-4516
Mailing Address - Country:US
Mailing Address - Phone:703-538-2065
Mailing Address - Fax:571-730-3227
Practice Address - Street 1:4715 15TH ST N
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22205-2640
Practice Address - Country:US
Practice Address - Phone:703-538-2065
Practice Address - Fax:571-327-3227
Is Sole Proprietor?:No
Enumeration Date:2014-08-01
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCRN1034410363LA2100X
VA24176815363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1235547316Medicaid