Provider Demographics
NPI:1952609067
Name:BARG, ROY A (CNA)
Entity Type:Individual
Prefix:
First Name:ROY
Middle Name:A
Last Name:BARG
Suffix:
Gender:M
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1124 CLUBHOUSE DR
Mailing Address - Street 2:SUITE 01
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-2676
Mailing Address - Country:US
Mailing Address - Phone:817-734-3973
Mailing Address - Fax:817-870-1057
Practice Address - Street 1:1124 CLUBHOUSE DR
Practice Address - Street 2:SUITE 01
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-2676
Practice Address - Country:US
Practice Address - Phone:817-734-3973
Practice Address - Fax:817-870-1057
Is Sole Proprietor?:No
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X, 246Y00000X, 2472D0500X, 374U00000X, 376K00000X
TXNA08676030374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No2472D0500XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherDarkroom
No376K00000XNursing Service Related ProvidersNurse's Aide