Provider Demographics
NPI:1518055235
Name:BOURDESS, BARBARA (CRNP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BOURDESS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:158 MILLERS RD
Mailing Address - Street 2:
Mailing Address - City:SIDMAN
Mailing Address - State:PA
Mailing Address - Zip Code:15955-3508
Mailing Address - Country:US
Mailing Address - Phone:814-534-0745
Mailing Address - Fax:814-536-5431
Practice Address - Street 1:119 WALNUT ST
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15901-1625
Practice Address - Country:US
Practice Address - Phone:814-534-0745
Practice Address - Fax:814-536-5431
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007489363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1587977OtherHIGHMARK
PA520197OtherVALUEOPTIONS
PA1012166170001Medicaid
PA1012166170001Medicaid
Q23037Medicare UPIN