Provider Demographics
NPI:1225510647
Name:BARR, RAVYN NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:RAVYN
Middle Name:NICOLE
Last Name:BARR
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:RAYVN
Other - Middle Name:NICOLE
Other - Last Name:MARSHALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3514 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1210
Practice Address - Country:US
Practice Address - Phone:067-251-8018
Practice Address - Fax:806-723-7535
Is Sole Proprietor?:No
Enumeration Date:2018-08-31
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138361363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX804145OtherMEDICARE
TX397836301Medicaid
NM73732249Medicaid
TX8KX176OtherBCBS