Provider Demographics
NPI:1417567629
Name:BARRY, DEBRA LYNNE
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:LYNNE
Last Name:BARRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:283 IDYLLWOOD DR
Mailing Address - Street 2:
Mailing Address - City:INWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:25428-3078
Mailing Address - Country:US
Mailing Address - Phone:304-821-4795
Mailing Address - Fax:
Practice Address - Street 1:283 IDYLLWOOD DR
Practice Address - Street 2:
Practice Address - City:INWOOD
Practice Address - State:WV
Practice Address - Zip Code:25428-3078
Practice Address - Country:US
Practice Address - Phone:304-821-4795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant