MEDICARE: BARRY M SKEEN CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	R514624	MS

General Provider Information

NPI Number	:	1982635918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARRY M SKEEN CRNA

Provider Business Mailing Address
First Line	:	1710 W 12TH ST
Second Line	:
City	:	LAUREL
State	:	MS
Zip	:	39440-2559
Country	:	US
Telephone Number	:	601-369-2021
Fax Number	:

Provider Business Practice Location Address
First Line	:	1710 W 12TH ST
Second Line	:
City	:	LAUREL
State	:	MS
Zip	:	39440-2559
Country	:	US
Telephone Number	:	601-369-2021
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	07/08/2007

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