Provider Demographics
NPI:1891234282
Name:BARNES, DENTON (PA)
Entity Type:Individual
Prefix:
First Name:DENTON
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 COX BLVD
Mailing Address - Street 2:
Mailing Address - City:GOLDSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27534-9479
Mailing Address - Country:US
Mailing Address - Phone:919-587-9040
Mailing Address - Fax:919-587-9047
Practice Address - Street 1:203 COX BLVD
Practice Address - Street 2:
Practice Address - City:GOLDSBORO
Practice Address - State:NC
Practice Address - Zip Code:27534-9479
Practice Address - Country:US
Practice Address - Phone:919-587-9040
Practice Address - Fax:919-587-9047
Is Sole Proprietor?:No
Enumeration Date:2017-02-17
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-06991363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1891234282Medicaid