Provider Demographics
NPI:1093802670
Name:BENTLEY, BARBARA (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BENTLEY
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 1:2001 KILBIRNIE DR
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38139-3404
Mailing Address - Country:US
Mailing Address - Phone:901-751-2067
Mailing Address - Fax:
Practice Address - Street 1:2001 KILBIRNIE DR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38139-3404
Practice Address - Country:US
Practice Address - Phone:901-751-2067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN11050367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3164167OtherB/C
430073516OtherRR MED
TN3902314Medicaid
TN3902314Medicaid