Provider Demographics
NPI:1972870459
Name:BARR, BEATRICE AMY (CHP)
Entity Type:Individual
Prefix:
First Name:BEATRICE
Middle Name:AMY
Last Name:BARR
Suffix:
Gender:F
Credentials:CHP
Other - Prefix:
Other - First Name:BEADY
Other - Middle Name:
Other - Last Name:BARR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CHP
Mailing Address - Street 1:51003 MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:KOBUK
Mailing Address - State:AK
Mailing Address - Zip Code:99751-0003
Mailing Address - Country:US
Mailing Address - Phone:907-948-2218
Mailing Address - Fax:907-948-2199
Practice Address - Street 1:51003 MAIN STREET
Practice Address - Street 2:
Practice Address - City:KOBUK
Practice Address - State:AK
Practice Address - Zip Code:99751-0003
Practice Address - Country:US
Practice Address - Phone:907-948-2218
Practice Address - Fax:907-948-2199
Is Sole Proprietor?:No
Enumeration Date:2011-11-28
Last Update Date:2011-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK00-407-P172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker