Healthcare Provider Details

I. General information

NPI: 1356471767
Provider Name (Legal Business Name): ANN REBECCA BARTHOLOMEW PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2007
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 WHITE ST STE 1
JACKSONVILLE NC
28546-6351
US

IV. Provider business mailing address

160 IRIS WAY
HAMPSTEAD NC
28443-3885
US

V. Phone/Fax

Practice location:
  • Phone: 910-577-4968
  • Fax: 910-577-2916
Mailing address:
  • Phone: 404-667-8370
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA3830
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number003302
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2016-0047
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110-004577
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA05207
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11181292-1206
License Number StateUT
# 7
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0010-10190
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: