Provider Demographics
NPI:1376520635
Name:BARDWELL, PRISCILLA ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:PRISCILLA
Middle Name:ANN
Last Name:BARDWELL
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 1:906 W MCDERMOTT DR # 116-371
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-6510
Mailing Address - Country:US
Mailing Address - Phone:469-541-1600
Mailing Address - Fax:469-541-1612
Practice Address - Street 1:4510 MEDICAL CENTER DR STE 211
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-1602
Practice Address - Country:US
Practice Address - Phone:469-541-1600
Practice Address - Fax:469-541-1612
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX551488367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX89869UOtherBCBS
TX897986OtherBCBS
TX172056706Medicaid
TX85013UOtherBCBS
TX172056702Medicaid
TX85013UOtherBCBS
Q38651Medicare UPIN
P00696208Medicare PIN
TX8L7831Medicare PIN
TX8F10029Medicare PIN
TX897986OtherBCBS
TX8D5561Medicare ID - Type Unspecified606K