Provider Demographics
NPI:1760600977
Name:BARRON, MARY LEE (APRN)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:LEE
Last Name:BARRON
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MISS
Other - First Name:MARY
Other - Middle Name:LEE
Other - Last Name:KIENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3660 VISTA AVE
Mailing Address - Street 2:DEPT OF FAMILY AND COMMUNITY MEDICINE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-2540
Mailing Address - Country:US
Mailing Address - Phone:314-977-8485
Mailing Address - Fax:
Practice Address - Street 1:3660 VISTA AVE
Practice Address - Street 2:DEPT OF FAMILY AND COMMUNITY MEDICINE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-2540
Practice Address - Country:US
Practice Address - Phone:314-977-8485
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2010-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO065287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily