Provider Demographics
NPI:1023074903
Name:BEATTY, BARBARA (CRNA)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:BEATTY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 RIVERSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:NARROWS
Mailing Address - State:VA
Mailing Address - Zip Code:24124-1124
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:PEARISBURG
Practice Address - State:VA
Practice Address - Zip Code:24134-1932
Practice Address - Country:US
Practice Address - Phone:540-921-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2008-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001052818163W00000X
VA0024052818367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA8934941Medicaid
VA8934941Medicaid
VA430001691Medicare ID - Type Unspecified
430001691Medicare PIN