Provider Demographics
NPI:1508370016
Name:BARRY, DALLAS (RN)
Entity Type:Individual
Prefix:
First Name:DALLAS
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ROCKFORD RD
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501-6263
Mailing Address - Country:US
Mailing Address - Phone:218-469-0641
Mailing Address - Fax:
Practice Address - Street 1:24276 AIRPORT RD
Practice Address - Street 2:166TH ST
Practice Address - City:EAGLEBUTTE
Practice Address - State:SD
Practice Address - Zip Code:57625-5762
Practice Address - Country:US
Practice Address - Phone:605-964-0568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2017-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR045661163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency