Healthcare Provider Details

I. General information

NPI: 1447215793
Provider Name (Legal Business Name): DAVID BARNES CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 09/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 WALLS DR
CLEBURNE TX
76033-4007
US

IV. Provider business mailing address

10120 TANTARRA DR
BURLESON TX
76028-7856
US

V. Phone/Fax

Practice location:
  • Phone: 817-641-2551
  • Fax:
Mailing address:
  • Phone: 817-447-4058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number616275
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: