Provider Demographics
NPI:1619004728
Name:COMBS, BARBARA JEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:JEAN
Last Name:COMBS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
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 776879
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6879
Mailing Address - Country:US
Mailing Address - Phone:502-272-5395
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:411 EAST CHESTNUT STREET
Practice Address - Street 2:LEVEL 5
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1713
Practice Address - Country:US
Practice Address - Phone:502-588-0390
Practice Address - Fax:502-588-0396
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4209363LP0200X
KY3004209363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100256400Medicaid