Provider Demographics
NPI:1639341274
Name:BARKLEY, LISA MILLER (CNM)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MILLER
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2368 VICKY LN
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-8594
Mailing Address - Country:US
Mailing Address - Phone:252-329-0515
Mailing Address - Fax:
Practice Address - Street 1:101 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7201
Practice Address - Country:US
Practice Address - Phone:252-758-4181
Practice Address - Fax:252-758-2603
Is Sole Proprietor?:No
Enumeration Date:2008-03-24
Last Update Date:2011-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9352367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7002028Medicaid
NC7002028Medicaid