Provider Demographics
NPI:1497786305
Name:MABERRY, CHARLEY D (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLEY
Middle Name:D
Last Name:MABERRY
Suffix:
Gender:M
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 163694
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76161-3694
Mailing Address - Country:US
Mailing Address - Phone:888-274-9585
Mailing Address - Fax:405-948-6507
Practice Address - Street 1:907 E EUREKA
Practice Address - Street 2:SUITE B
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76086
Practice Address - Country:US
Practice Address - Phone:817-598-9325
Practice Address - Fax:817-599-4902
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230407367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
86152HMedicare ID - Type Unspecified