Provider Demographics
NPI:1760464515
Name:BARBEE, LISA (CRNA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:BARBEE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:BARBEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:5353 KELLER SPRINGS RD
Mailing Address - Street 2:APT 1223
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75248-2778
Mailing Address - Country:US
Mailing Address - Phone:336-287-5223
Mailing Address - Fax:
Practice Address - Street 1:5353 KELLER SPRINGS RD
Practice Address - Street 2:APT 1223
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75248-2778
Practice Address - Country:US
Practice Address - Phone:336-287-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-17
Last Update Date:2013-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC091389367500000X
TX507848367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCOA105511OtherMEDICARE ID
NC8050241Medicaid
NC8050241Medicaid