Provider Demographics
NPI:1760784524
Name:BARRETT, BRIAN (CRNA)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4218 SILVER GLADE TRL
Mailing Address - Street 2:
Mailing Address - City:SELLERSBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47172-1773
Mailing Address - Country:US
Mailing Address - Phone:812-207-5155
Mailing Address - Fax:
Practice Address - Street 1:4218 SILVER GLADE TRL
Practice Address - Street 2:
Practice Address - City:SELLERSBURG
Practice Address - State:IN
Practice Address - Zip Code:47172-1773
Practice Address - Country:US
Practice Address - Phone:812-207-5155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-30
Last Update Date:2010-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1094184367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered