Provider Demographics
NPI:1174512933
Name:KEITH, BARBARA DUST (FNP)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:DUST
Last Name:KEITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5221 PARAMOUNT PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:MORRISVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27560-5490
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1249 CHICKEN FOOT RD
Practice Address - Street 2:
Practice Address - City:HOPE MILLS
Practice Address - State:NC
Practice Address - Zip Code:28348-7525
Practice Address - Country:US
Practice Address - Phone:910-423-1278
Practice Address - Fax:910-423-2547
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC201831363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q12320Medicare UPIN
NC2809491Medicare ID - Type Unspecified