Provider Demographics
NPI:1780679720
Name:BARIBEAULT, RIC (CRNA)
Entity Type:Individual
Prefix:
First Name:RIC
Middle Name:
Last Name:BARIBEAULT
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2401 S 31ST ST
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76508-4832
Practice Address - Country:US
Practice Address - Phone:254-724-2111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2023-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX711764367500000X
PARN531594163W00000X
PA053398367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2035826000OtherINDEP. BLUE CROSS
TXP00711697OtherRAILROAD MEDICARE
PA03221201OtherCAPITAL ADVANTAGE
PA75822OtherGEISINGER
TX171672203Medicaid
TX8083UUOtherBLUE CROSS BLUE SHIELD
PA1343154OtherKHP CENTRAL
PA1343154OtherHIGHMARK
PA430070453OtherRAIL ROAD MEDICARE
PAP49551Medicare UPIN
PA054526QCYMedicare ID - Type UnspecifiedMEDICARE
PA75822OtherGEISINGER