Provider Demographics
NPI:1366709123
Name:BARR, KRISTEN COLLIN (CRNA)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:COLLIN
Last Name:BARR
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 W TIPTON ST
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-2363
Mailing Address - Country:US
Mailing Address - Phone:812-522-2349
Mailing Address - Fax:812-522-0532
Practice Address - Street 1:411 W TIPTON ST
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-2363
Practice Address - Country:US
Practice Address - Phone:812-522-2349
Practice Address - Fax:812-522-0532
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR862373163W00000X
TNAPN 16741367500000X
IN28218564367500000X
IN28218564A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR193553001Medicaid
INQ00787037OtherRAILROAD PTAN
IN940070025OtherMEDICARE PTAN
MS05152506Medicaid
IN1102530297OtherANTHEM PTAN
TN1528845Medicaid
1366709123OtherCHAMPUS/TRICARE
IN163460064OtherMEDICARE PTAN
IN201250290Medicaid
IN300086622Medicaid
TN4326170OtherBCBST