Healthcare Provider Details

I. General information

NPI: 1467309187
Provider Name (Legal Business Name): WILLIAM E BARNES FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2026
Last Update Date: 04/16/2026
Certification Date: 04/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4520 BROAD ST
LORIS SC
29569-2422
US

IV. Provider business mailing address

4520 BROAD ST
LORIS SC
29569-2422
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31671
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: