Provider Demographics
NPI:1013704196
Name:CRISSMAN, BARBARA ELLEN
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:ELLEN
Last Name:CRISSMAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 COUNTRY CLUB LN APT 8
Mailing Address - Street 2:
Mailing Address - City:KITTANNING
Mailing Address - State:PA
Mailing Address - Zip Code:16201-8937
Mailing Address - Country:US
Mailing Address - Phone:724-859-4051
Mailing Address - Fax:
Practice Address - Street 1:107 COUNTRY CLUB LN APT 8
Practice Address - Street 2:
Practice Address - City:KITTANNING
Practice Address - State:PA
Practice Address - Zip Code:16201-8937
Practice Address - Country:US
Practice Address - Phone:724-859-4051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-22
Last Update Date:2025-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP030111363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily