Provider Demographics
NPI:1932447695
Name:BARRON, GREGORY (NP-C, MSN, RN)
Entity Type:Individual
Prefix:MR
First Name:GREGORY
Middle Name:
Last Name:BARRON
Suffix:
Gender:M
Credentials:NP-C, MSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3080 E GENTRY WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83642-3544
Mailing Address - Country:US
Mailing Address - Phone:208-286-8670
Mailing Address - Fax:888-990-2969
Practice Address - Street 1:39 W PINE AVE STE B20
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:ID
Practice Address - Zip Code:83642-2412
Practice Address - Country:US
Practice Address - Phone:208-286-8670
Practice Address - Fax:866-807-6068
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-30
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1247A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDF1212171OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NUMBER
IDNP-1247AOtherADVANCED PRACTICE LICENSE NUMBER
IDN-26878OtherREGISTERED NURSE LICENSE NUMBER