Provider Demographics
NPI:1982104543
Name:BARN, EVELYN FAY (LVN)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:FAY
Last Name:BARN
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 353
Mailing Address - Street 2:
Mailing Address - City:ALBA
Mailing Address - State:TX
Mailing Address - Zip Code:75410-0353
Mailing Address - Country:US
Mailing Address - Phone:903-768-3063
Mailing Address - Fax:
Practice Address - Street 1:440 PRIVATE ROAD 5610
Practice Address - Street 2:
Practice Address - City:GRAND SALINE
Practice Address - State:TX
Practice Address - Zip Code:75140-5332
Practice Address - Country:US
Practice Address - Phone:903-283-5958
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122485164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse