Provider Demographics
NPI:1740532357
Name:BARRY, ANDREA AUSTIN (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ANDREA
Middle Name:AUSTIN
Last Name:BARRY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:LYNN
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:2701 20TH AVE.
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476
Mailing Address - Country:US
Mailing Address - Phone:205-333-5900
Mailing Address - Fax:205-333-6090
Practice Address - Street 1:2701 20TH AVE.
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476
Practice Address - Country:US
Practice Address - Phone:205-333-5900
Practice Address - Fax:205-333-6090
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-120739363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL142664Medicaid
AL1740532357Medicaid