Provider Demographics
NPI:1720007511
Name:BARNETT, SUE FORTAG (FNP)
Entity Type:Individual
Prefix:MRS
First Name:SUE
Middle Name:FORTAG
Last Name:BARNETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2280 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27530-9546
Mailing Address - Country:US
Mailing Address - Phone:919-731-1000
Mailing Address - Fax:919-731-1232
Practice Address - Street 1:2280 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27530-9546
Practice Address - Country:US
Practice Address - Phone:919-735-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC005001301363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2592599OtherMEDICARE/CIGNA
NC7003801Medicaid
NC7003801Medicaid