Provider Demographics
NPI:1215712948
Name:BARRENTINE, ERNEST
Entity type:Individual
Prefix:
First Name:ERNEST
Middle Name:
Last Name:BARRENTINE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 S MARION ST
Mailing Address - Street 2:
Mailing Address - City:LATTA
Mailing Address - State:SC
Mailing Address - Zip Code:29565-1519
Mailing Address - Country:US
Mailing Address - Phone:843-250-5472
Mailing Address - Fax:
Practice Address - Street 1:307 S MARION ST
Practice Address - Street 2:
Practice Address - City:LATTA
Practice Address - State:SC
Practice Address - Zip Code:29565-1519
Practice Address - Country:US
Practice Address - Phone:843-250-5472
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC266884163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency