Provider Demographics
NPI:1083717458
Name:BARHAM, JO CARROLL (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JO
Middle Name:CARROLL
Last Name:BARHAM
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 650802
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75265-0802
Mailing Address - Country:US
Mailing Address - Phone:972-715-5000
Mailing Address - Fax:
Practice Address - Street 1:5010 CRENSHAW RD
Practice Address - Street 2:SUITE #130
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-3097
Practice Address - Country:US
Practice Address - Phone:281-991-2200
Practice Address - Fax:281-991-7700
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX429306367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0046CCOtherMEDICARE RPK GROUP #
TX8717UAOtherBCBS
TX139992531Medicaid
TX139992531Medicaid
TXTXB122013Medicare PIN
TX82821HMedicare PIN
TXTXB115843Medicare PIN