Basic Information
| Provider Information | |||||||||
| NPI: | 1376977645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNES | ||||||||
| FirstName: | MARTHA | ||||||||
| MiddleName: | LAUREN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 640 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278700640 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365791 | ||||||||
| FaxNumber: | 2525365444 | ||||||||
| Practice Location | |||||||||
| Address1: | 2066 NC HIGHWAY 125 | ||||||||
| Address2: | |||||||||
| City: | ROANOKE RAPIDS | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278709436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2525365000 | ||||||||
| FaxNumber: | 2525362258 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/22/2013 | ||||||||
| LastUpdateDate: | 08/22/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | L004129 | NC | Y | Dietary & Nutritional Service Providers | Dietitian, Registered |
No ID Information.