Provider Demographics
NPI:1639984222
Name:BARBOUR, NATHANIEL TERRON
Entity type:Individual
Prefix:
First Name:NATHANIEL
Middle Name:TERRON
Last Name:BARBOUR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RING RD STE 155
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-8790
Mailing Address - Country:US
Mailing Address - Phone:606-215-2328
Mailing Address - Fax:
Practice Address - Street 1:400 RING RD STE 155
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-8790
Practice Address - Country:US
Practice Address - Phone:606-215-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-11
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility