Provider Demographics
NPI:1477548568
Name:BREZAVAR, BARBARA J (CRNA)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:J
Last Name:BREZAVAR
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:PO BOX 842120
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64184-2120
Mailing Address - Country:US
Mailing Address - Phone:417-239-3392
Mailing Address - Fax:417-239-3394
Practice Address - Street 1:251 SKAGGS RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-2031
Practice Address - Country:US
Practice Address - Phone:800-277-8151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO098991367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO915084628Medicaid
MOP00194818OtherRAILROAD
AR158888001Medicaid
MO15566OtherCOX HEALTH
MO738921OtherHEALTHLINK
MO194111OtherBCBS
OK200077430AMedicaid
MO20174319965616B007OtherTRICARE
AR158888001Medicaid