Healthcare Provider Details

I. General information

NPI: 1659352789
Provider Name (Legal Business Name): BARRY O KULP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2005
Last Update Date: 04/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

515 MAIN ST
OLEAN NY
14760-1513
US

IV. Provider business mailing address

202 N BARRY ST
OLEAN NY
14760-2723
US

V. Phone/Fax

Practice location:
  • Phone: 716-372-0223
  • Fax: 716-373-7191
Mailing address:
  • Phone: 716-372-0223
  • Fax: 716-373-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number272764-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: