MEDICARE: MRS. GAIL SMITH-BARBOUR RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	205288	NC
2	163WP0809X	Adult Psychiatric/Mental Health Registered Nurse	205288	NC
3	163WP0807X	Child & Adolescent Psychiatric/Mental Health Registered Nurse	205288	NC

General Provider Information

NPI Number	:	1497992168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GAIL SMITH-BARBOUR RN

Provider Business Mailing Address
First Line	:	3324 WRANGLER LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-2169
Country	:	US
Telephone Number	:	240-304-5310
Fax Number	:

Provider Business Practice Location Address
First Line	:	3324 WRANGLER LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28213-2169
Country	:	US
Telephone Number	:	240-304-5310
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2009
Last Update Date	:	01/16/2009

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