Provider Demographics
NPI:1669612487
Name:BARRETT, ERIC JASON (CRNA)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:JASON
Last Name:BARRETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1175 OLD HIGHWAY 92
Mailing Address - Street 2:
Mailing Address - City:LEIGHTON
Mailing Address - State:IA
Mailing Address - Zip Code:50143-8065
Mailing Address - Country:US
Mailing Address - Phone:641-660-1695
Mailing Address - Fax:
Practice Address - Street 1:1002 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:IA
Practice Address - Zip Code:50138-3121
Practice Address - Country:US
Practice Address - Phone:641-842-2151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAD115174367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1669612487OtherNPI