Basic Information
| Provider Information | |||||||||
| NPI: | 1194708784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRON | ||||||||
| FirstName: | SUZANNE | ||||||||
| MiddleName: | D | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 390 S MAIN ST | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | VA | ||||||||
| PostalCode: | 241511766 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5404844836 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4348 ELECTRIC RD | ||||||||
| Address2: | |||||||||
| City: | ROANOKE | ||||||||
| State: | VA | ||||||||
| PostalCode: | 240180720 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4076909755 | ||||||||
| FaxNumber: | 5407728219 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 0024-094237 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | 10309867 | 05 | VA | MEDICAID | 7793731 | 05 | VA | MEDICAID |