Provider Demographics
NPI:1457456204
Name:RUSSIFF, BARBARA (FNPC)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:
Last Name:RUSSIFF
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 844693
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4693
Mailing Address - Country:US
Mailing Address - Phone:903-416-6325
Mailing Address - Fax:903-416-6326
Practice Address - Street 1:5012 S US HIGHWAY 75
Practice Address - Street 2:SUITE 100
Practice Address - City:DENISON
Practice Address - State:TX
Practice Address - Zip Code:75020-4587
Practice Address - Country:US
Practice Address - Phone:903-416-6285
Practice Address - Fax:903-416-6286
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117289363LF0000X
OK112223363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily