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General NPI Number Information
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NPI Number | 1508370016
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Entity Type | Individual
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Provider Name | DALLAS BARRY RN, APN
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Gender | Female
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 02/25/2025
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Provider Practice Location Address
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Address Line | 24276 AIRPORT RD 166TH ST
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City | EAGLEBUTTE
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State | SD
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Zip | 57625-5762
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Country | US
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Telephone | 605-964-0568
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Fax |
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Provider Business Mailing Address
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Address Line | 207 N BYRNE AVE
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City | AGAR
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State | SD
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Zip | 57520-5312
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Country | US
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Telephone | 218-469-0641
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | CP003152
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License Number State | SD
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Taxonomy #2
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Taxonomy Code | 163WE0003X
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Taxonomy Name | Emergency Registered Nurse
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License Number | R045661
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License Number State | SD
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