Provider Demographics
NPI:1255668109
Name:BARRACLOUGH, NANCY LEE (ANP-BC)
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LEE
Last Name:BARRACLOUGH
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:MS
Other - First Name:NANCY
Other - Middle Name:LEE
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ANP-BC
Mailing Address - Street 1:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-1368
Mailing Address - Country:US
Mailing Address - Phone:518-886-5112
Mailing Address - Fax:518-693-4490
Practice Address - Street 1:3050 ROUTE 50
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-2958
Practice Address - Country:US
Practice Address - Phone:518-886-5112
Practice Address - Fax:518-693-4490
Is Sole Proprietor?:No
Enumeration Date:2009-11-13
Last Update Date:2015-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY305151-1363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03353091Medicaid
NYJ400148611Medicare PIN