Provider Demographics
NPI:1831196344
Name:BARHAM, JILL HARPER (PA-C, MHS, CPO)
Entity type:Individual
Prefix:MRS
First Name:JILL
Middle Name:HARPER
Last Name:BARHAM
Suffix:
Gender:F
Credentials:PA-C, MHS, CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6208 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6286
Mailing Address - Country:US
Mailing Address - Phone:919-806-3910
Mailing Address - Fax:919-806-3430
Practice Address - Street 1:6208 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6286
Practice Address - Country:US
Practice Address - Phone:919-806-3910
Practice Address - Fax:919-806-3430
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC103244363AM0700X
NCCPO02762224P00000X, 222Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7795092Medicaid