Healthcare Provider Details

I. General information

NPI: 1255765095
Provider Name (Legal Business Name): MARY BETH BARNA PNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY BETH BARNA PNP

II. Dates (important events)

Enumeration Date: 08/28/2013
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 DOCTORS CIR SUITE 3
SUPPLY NC
28462-4097
US

IV. Provider business mailing address

14 DOCTORS CIR SUITE 3
SUPPLY NC
28462-4097
US

V. Phone/Fax

Practice location:
  • Phone: 910-754-7075
  • Fax: 910-754-2158
Mailing address:
  • Phone: 910-754-7075
  • Fax: 910-754-2158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number162702
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: