Healthcare Provider Details

I. General information

NPI: 1336683960
Provider Name (Legal Business Name): JENEFER L BARRY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2016
Last Update Date: 12/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 COLLEGE AVE
BEAVER PA
15009-2706
US

IV. Provider business mailing address

1 PEARTREE WAY
BEAVER PA
15009-1954
US

V. Phone/Fax

Practice location:
  • Phone: 724-774-4070
  • Fax: 724-774-2872
Mailing address:
  • Phone: 724-773-8960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberSP017017
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: