Healthcare Provider Details

I. General information

NPI: 1659981348
Provider Name (Legal Business Name): JOHN DAVID BARRERA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/06/2020
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S IH 35
PEARSALL TX
78061-6601
US

IV. Provider business mailing address

PO BOX 2135
LYTLE TX
78052-2135
US

V. Phone/Fax

Practice location:
  • Phone: 830-334-3617
  • Fax:
Mailing address:
  • Phone: 210-240-4084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1006990
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: