Healthcare Provider Details

I. General information

NPI: 1184604159
Provider Name (Legal Business Name): CYNTHIA WHITLEY BARNHARDT NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5370 RIDGE RD
CHARLOTTE NC
28269-0447
US

IV. Provider business mailing address

PO BOX 602344
CHARLOTTE NC
28260-2344
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-1491
  • Fax: 704-316-1492
Mailing address:
  • Phone: 704-403-3664
  • Fax: 704-403-3665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number01914
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: