Healthcare Provider Details

I. General information

NPI: 1528087590
Provider Name (Legal Business Name): BARRY EUGENE CHAPMAN ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 06/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 E BROADWAY ST SUITE 102
ALTUS OK
73521-5505
US

IV. Provider business mailing address

1015 E BROADWAY ST STE 102 P.O. BOX 575
ALTUS OK
73521-5506
US

V. Phone/Fax

Practice location:
  • Phone: 580-480-1600
  • Fax: 580-480-1601
Mailing address:
  • Phone: 580-480-1600
  • Fax: 580-480-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0069302
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number668386
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: