Provider Demographics
NPI:1578500138
Name:BARILLAS, ROGER O (ARNP)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:O
Last Name:BARILLAS
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 US HIGHWAY 18 E
Mailing Address - Street 2:
Mailing Address - City:CLEAR LAKE
Mailing Address - State:IA
Mailing Address - Zip Code:50428-2162
Mailing Address - Country:US
Mailing Address - Phone:641-357-1999
Mailing Address - Fax:
Practice Address - Street 1:1801 US HIGHWAY 18 E
Practice Address - Street 2:
Practice Address - City:CLEAR LAKE
Practice Address - State:IA
Practice Address - Zip Code:50428-2162
Practice Address - Country:US
Practice Address - Phone:641-357-1999
Practice Address - Fax:641-357-1999
Is Sole Proprietor?:No
Enumeration Date:2006-06-01
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAA086935363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0460956Medicaid
IAP00427171OtherRAILROAD MEDICARE
IAI14958Medicare PIN
IA0460956Medicaid