Provider Demographics
NPI:1972006419
Name:BARRON, MICHAEL HARRIS (NP-C)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:HARRIS
Last Name:BARRON
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1031 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:BALDWYN
Mailing Address - State:MS
Mailing Address - Zip Code:38824-1173
Mailing Address - Country:US
Mailing Address - Phone:662-365-9305
Mailing Address - Fax:
Practice Address - Street 1:1031 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:BALDWYN
Practice Address - State:MS
Practice Address - Zip Code:38824-1173
Practice Address - Country:US
Practice Address - Phone:662-365-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-12
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902420363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06434705Medicaid