Basic Information
| Provider Information | |||||||||
| NPI: | 1932447695 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRON | ||||||||
| FirstName: | GREGORY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | NP-C, MSN, RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3080 E GENTRY WAY | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836423544 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082868670 | ||||||||
| FaxNumber: | 8889902969 | ||||||||
| Practice Location | |||||||||
| Address1: | 39 W PINE AVE STE B20 | ||||||||
| Address2: | |||||||||
| City: | MERIDIAN | ||||||||
| State: | ID | ||||||||
| PostalCode: | 836422412 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2082868670 | ||||||||
| FaxNumber: | 8668076068 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/30/2013 | ||||||||
| LastUpdateDate: | 05/22/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 05/22/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NP-1247A | ID | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | F1212171 | 01 | ID | AMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION NUMBER | OTHER | NP-1247A | 01 | ID | ADVANCED PRACTICE LICENSE NUMBER | OTHER | N-26878 | 01 | ID | REGISTERED NURSE LICENSE NUMBER | OTHER |