Healthcare Provider Details

I. General information

NPI: 1881236248
Provider Name (Legal Business Name): ADRIENNE NICOLE BARROW FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 11/26/2020
Certification Date: 11/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14169 MANCHESTER RD STE C
MANCHESTER MO
63011-4525
US

IV. Provider business mailing address

14169 MANCHESTER RD STE C
MANCHESTER MO
63011-4525
US

V. Phone/Fax

Practice location:
  • Phone: 636-220-1470
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2018036141
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209020142
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: