Provider Demographics
NPI:1649892753
Name:BARRY, BREANNA LAICE (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:BREANNA
Middle Name:LAICE
Last Name:BARRY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1264 TAMU BLDG 520
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77843-0001
Mailing Address - Country:US
Mailing Address - Phone:979-458-8337
Mailing Address - Fax:979-458-8326
Practice Address - Street 1:311 HOUSTON STREET BLDG 520
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77843-7855
Practice Address - Country:US
Practice Address - Phone:979-458-8337
Practice Address - Fax:979-458-8326
Is Sole Proprietor?:No
Enumeration Date:2020-05-12
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF10190950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX10190950OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS