Healthcare Provider Details

I. General information

NPI: 1215991872
Provider Name (Legal Business Name): BARBARA JEAN MYRICK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 TAYLOR DR
DANVILLE VA
24541-4023
US

IV. Provider business mailing address

1615 OLDE HUNTING TRL
DANVILLE VA
24540-5107
US

V. Phone/Fax

Practice location:
  • Phone: 434-797-1040
  • Fax: 434-791-5342
Mailing address:
  • Phone: 434-793-5899
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024165967
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN49992
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: