Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LN0000X | Nurse Practitioner - Neonatal | 19782 | SC |
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 19782 | SC |
NPI | 1124497722 |
---|---|
Provider Name | Mrs. Brittany Barefoot Bostic |
First Address | Lexington, SC 29072-4300 |
Second Address | Charleston, SC 29401-1113 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/09/2015 |
Last Update Date | 28/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
NP3795 | (05) | SC |