Provider Demographics
NPI:1174341705
Name:CARRENDER, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:CARRENDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 MADELINES PARK DR
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-7333
Mailing Address - Country:US
Mailing Address - Phone:573-821-0817
Mailing Address - Fax:
Practice Address - Street 1:1513 UNION AVE STE 2500
Practice Address - Street 2:
Practice Address - City:MOBERLY
Practice Address - State:MO
Practice Address - Zip Code:65270-9412
Practice Address - Country:US
Practice Address - Phone:660-372-1313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-02
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024038701363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health