Healthcare Provider Details

I. General information

NPI: 1629011358
Provider Name (Legal Business Name): DARIK SHANE BARGER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/19/2023
Certification Date: 10/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 N MAIN AVE
ERWIN TN
37650-1508
US

IV. Provider business mailing address

1112 N MAIN AVE
ERWIN TN
37650-1508
US

V. Phone/Fax

Practice location:
  • Phone: 423-560-6010
  • Fax: 423-560-6011
Mailing address:
  • Phone: 423-560-6010
  • Fax: 423-560-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number104880
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7172
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: