Healthcare Provider Details

I. General information

NPI: 1144743071
Provider Name (Legal Business Name): MARYBETH BARCOME FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2017
Last Update Date: 04/14/2025
Certification Date: 04/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4566 E INVERNESS AVE STE 205
MESA AZ
85206-4634
US

IV. Provider business mailing address

2525 W GREENWAY RD STE 125
PHOENIX AZ
85023-4226
US

V. Phone/Fax

Practice location:
  • Phone: 480-573-0130
  • Fax: 480-573-0131
Mailing address:
  • Phone: 480-573-0130
  • Fax: 480-573-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP10147
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: