Provider Demographics
NPI:1659981348
Name:BARRERA, JOHN DAVID (FNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:BARRERA
Suffix:
Gender:M
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 2135
Mailing Address - Street 2:
Mailing Address - City:LYTLE
Mailing Address - State:TX
Mailing Address - Zip Code:78052-2135
Mailing Address - Country:US
Mailing Address - Phone:210-240-4084
Mailing Address - Fax:
Practice Address - Street 1:200 S IH 35
Practice Address - Street 2:
Practice Address - City:PEARSALL
Practice Address - State:TX
Practice Address - Zip Code:78061-6601
Practice Address - Country:US
Practice Address - Phone:830-334-3617
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1006990363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily