Provider Demographics
NPI:1255970869
Name:BARTON, FREDERICK LOUIS (NP)
Entity type:Individual
Prefix:
First Name:FREDERICK
Middle Name:LOUIS
Last Name:BARTON
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1525 BLANTON AVE SE
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24014-5803
Mailing Address - Country:US
Mailing Address - Phone:240-353-2042
Mailing Address - Fax:
Practice Address - Street 1:1525 BLANTON AVE SE
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24014-5803
Practice Address - Country:US
Practice Address - Phone:240-353-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-30
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT198672363LF0000X
VA0024178830363LF0000X
GARN282379163W00000X
KSTMP-159931363LF0000X
NY0347021363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse