Provider Demographics
NPI:1851586077
Name:BARRY, JAYNE ANNE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:JAYNE
Middle Name:ANNE
Last Name:BARRY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 E. LEE STREET
Mailing Address - Street 2:
Mailing Address - City:WINSLOW
Mailing Address - State:AZ
Mailing Address - Zip Code:86047
Mailing Address - Country:US
Mailing Address - Phone:928-289-3396
Mailing Address - Fax:928-289-2801
Practice Address - Street 1:200 E. LEE STREET
Practice Address - Street 2:
Practice Address - City:WINSLOW
Practice Address - State:AZ
Practice Address - Zip Code:86047
Practice Address - Country:US
Practice Address - Phone:928-289-3396
Practice Address - Fax:928-289-2801
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP2830363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ417389Medicaid
AZZ127648Medicare PIN