Healthcare Provider Details

I. General information

NPI: 1083943765
Provider Name (Legal Business Name): LEAH CAROLINE BAREFOOT CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2009
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 HERBERT CT ECU PHYSICIANS PEDIATRIC GASTROENTEROLOGY
GREENVILLE NC
27834-3736
US

IV. Provider business mailing address

PO BOX 751069 ECU PHYSICIANS
CHARLOTTE NC
28275-1069
US

V. Phone/Fax

Practice location:
  • Phone: 252-744-5437
  • Fax: 252-744-1514
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024168123
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number202798
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: