Healthcare Provider Details

I. General information

NPI: 1902413982
Provider Name (Legal Business Name): JUSTIN KYLE BARBER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2020
Last Update Date: 09/24/2020
Certification Date: 09/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 VETERANS DR
FLORENCE AL
35630-4928
US

IV. Provider business mailing address

408 W CANDLER AVE
MUSCLE SHOALS AL
35661-3302
US

V. Phone/Fax

Practice location:
  • Phone: 256-629-1000
  • Fax:
Mailing address:
  • Phone: 256-394-0649
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-133744
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: