Provider Demographics
NPI:1619592300
Name:BARRY FAMILY PRACTICE
Entity Type:Organization
Organization Name:BARRY FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:563-608-3888
Mailing Address - Street 1:3073 140TH AVE
Mailing Address - Street 2:
Mailing Address - City:RYAN
Mailing Address - State:IA
Mailing Address - Zip Code:52330-8515
Mailing Address - Country:US
Mailing Address - Phone:563-608-3888
Mailing Address - Fax:
Practice Address - Street 1:1394 LOCUST ST
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52001-4781
Practice Address - Country:US
Practice Address - Phone:563-608-3888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-09
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty