=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891916839
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ANNA BARBOUR MASSENGILL RNC, WHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/01/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 45 SHOTWELL ROAD
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27520
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-550-5354
-----------------------------------------------------
Fax | 919-550-5766
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1134 HAYES ROAD
-----------------------------------------------------
City | FOUR OAKS
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 27524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 919-894-5424
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LW0102X
-----------------------------------------------------
Taxonomy Name | Women's Health Nurse Practitioner
-----------------------------------------------------
License Number | 800103
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------