Provider Demographics
NPI:1558475723
Name:CRISWELL, BARBARA DEW (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:DEW
Last Name:CRISWELL
Suffix:
Gender:F
Credentials:FNP
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 27
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:MS
Mailing Address - Zip Code:38921-0027
Mailing Address - Country:US
Mailing Address - Phone:662-647-5816
Mailing Address - Fax:662-647-5705
Practice Address - Street 1:100 N COURT ST
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:MS
Practice Address - Zip Code:38957-9710
Practice Address - Country:US
Practice Address - Phone:662-375-9989
Practice Address - Fax:662-375-8762
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR532355363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00114642Medicaid
MS500001378OtherMEDICARE PART B
MS$$$$$$$$$COtherBCBS (SUMNER)
MS$$$$$$$$$COtherBCBS (SUMNER)