Provider Demographics
NPI:1336683960
Name:BARRY, JENEFER L (FNP)
Entity Type:Individual
Prefix:
First Name:JENEFER
Middle Name:L
Last Name:BARRY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 PEARTREE WAY
Mailing Address - Street 2:
Mailing Address - City:BEAVER
Mailing Address - State:PA
Mailing Address - Zip Code:15009-1954
Mailing Address - Country:US
Mailing Address - Phone:724-773-8960
Mailing Address - Fax:
Practice Address - Street 1:250 COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:BEAVER
Practice Address - State:PA
Practice Address - Zip Code:15009-2706
Practice Address - Country:US
Practice Address - Phone:724-774-4070
Practice Address - Fax:724-774-2872
Is Sole Proprietor?:No
Enumeration Date:2016-12-16
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP017017363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner