Healthcare Provider Details

I. General information

NPI: 1982632014
Provider Name (Legal Business Name): KEVEN L. BARBER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 12/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 S GLOSTER ST
TUPELO MS
38801-4934
US

IV. Provider business mailing address

P.O. BOX 3488, DEPT. 05-003
TUPELO MS
38803
US

V. Phone/Fax

Practice location:
  • Phone: 662-377-4394
  • Fax: 662-377-7045
Mailing address:
  • Phone: 662-377-4394
  • Fax: 662-377-4394

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR855204
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: