Provider Demographics
NPI:1265489827
Name:FULBRIGHT, BARBARA F (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:F
Last Name:FULBRIGHT
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 1:6801 DIXIE HWY
Mailing Address - Street 2:SUITE 130
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40258-3913
Mailing Address - Country:US
Mailing Address - Phone:502-451-5855
Mailing Address - Fax:502-479-1409
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-361-6617
Practice Address - Fax:502-361-6637
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY930A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY74367616Medicaid
KY430052671OtherRR MEDICARE
KY74367616Medicaid
KY0609019Medicare PIN
KY430052671OtherRR MEDICARE