Healthcare Provider Details

I. General information

NPI: 1508667122
Provider Name (Legal Business Name): ELISABETH GRACE BARNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 MAIN ST
CONWAY SC
29526-3634
US

IV. Provider business mailing address

1301 MAIN ST
CONWAY SC
29526-3634
US

V. Phone/Fax

Practice location:
  • Phone: 843-703-1027
  • Fax:
Mailing address:
  • Phone: 843-703-1027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number30748
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: