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General NPI Number Information
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NPI Number | 1376191197
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Entity Type | Individual
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Provider Name | COURTNEY SHANE BARRETT NP
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Gender | Female
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Dates
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Enumeration Date | 08/27/2019
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Last Update Date | 08/27/2019
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Provider Practice Location Address
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Address Line | 12522 W COLONIAL TRAIL HWY
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City | CREWE
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State | VA
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Zip | 23930-3329
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Country | US
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Telephone | 434-645-9191
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Fax | 434-645-1859
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Provider Business Mailing Address
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Address Line | 14490 MEADE RD
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City | AMELIA COURT HOUSE
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State | VA
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Zip | 23002-4502
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Country | US
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Telephone | 252-394-6162
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 0024177935
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License Number State | VA
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