Provider Demographics
NPI:1063969178
Name:BARRY, KEARSTIN
Entity type:Individual
Prefix:
First Name:KEARSTIN
Middle Name:
Last Name:BARRY
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 1:8310 HILLVILLE RD
Mailing Address - Street 2:
Mailing Address - City:BLUFFTON
Mailing Address - State:OH
Mailing Address - Zip Code:45817-8564
Mailing Address - Country:US
Mailing Address - Phone:567-204-1834
Mailing Address - Fax:
Practice Address - Street 1:8310 HILLVILLE RD
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:OH
Practice Address - Zip Code:45817
Practice Address - Country:US
Practice Address - Phone:567-204-1834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program