Provider Demographics
NPI:1417975434
Name:BARCLAY, GAYRENE A (NP)
Entity Type:Individual
Prefix:
First Name:GAYRENE
Middle Name:A
Last Name:BARCLAY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:GAYE
Other - Middle Name:A
Other - Last Name:BARCLAY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN
Mailing Address - Street 1:11310 SUNSHINE PARK DR
Mailing Address - Street 2:
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77429-3080
Mailing Address - Country:US
Mailing Address - Phone:281-469-0982
Mailing Address - Fax:
Practice Address - Street 1:16655 SOUTHWEST FWY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-2329
Practice Address - Country:US
Practice Address - Phone:281-274-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX558318363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX148663101Medicaid
TX8Y0319OtherBLUE CROSS BLUE SHIELD
TX8G7209Medicare PIN
TXP48336Medicare UPIN