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General NPI Number Information
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NPI Number | 1053794248
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Entity Type | Individual
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Provider Name | KEITH BARNHARDT
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Gender | Male
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Dates
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Enumeration Date | 07/07/2015
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Last Update Date | 07/20/2016
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Provider Practice Location Address
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Address Line | 135 SOUTH C. STREET
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City | FAYETTEVILLE
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State | NC
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Zip | 28301-4104
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Country | US
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Telephone | 910-779-0781
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Fax |
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Provider Business Mailing Address
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Address Line | 1624 SOUND WATCH DR
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City | WILMINGTON
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State | NC
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Zip | 28409-4562
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Country | US
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Telephone | 910-540-2421
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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