Provider Demographics
NPI:1124497722
Name:BOSTIC, BRITTANY BAREFOOT
Entity type:Individual
Prefix:MRS
First Name:BRITTANY
Middle Name:BAREFOOT
Last Name:BOSTIC
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:BRITTANY
Other - Middle Name:
Other - Last Name:BAREFOOT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:131 TYBO DR
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-4300
Mailing Address - Country:US
Mailing Address - Phone:864-992-1522
Mailing Address - Fax:
Practice Address - Street 1:316 CALHOUN ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1113
Practice Address - Country:US
Practice Address - Phone:843-402-1638
Practice Address - Fax:843-724-2455
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC19782363LN0000X, 363LN0005X
SC217218163WN0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0005XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal, Critical Care
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal
No163WN0002XNursing Service ProvidersRegistered NurseNeonatal Intensive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP3795Medicaid