1265840094 NPI number — MS. DESIREE KAY BARNETT BSN RN ADMIN/DCS

Table of content: JORDAN MARK READER DO (NPI 1770146862)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265840094 NPI number — MS. DESIREE KAY BARNETT BSN RN ADMIN/DCS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNETT
Provider First Name:
DESIREE
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BSN RN ADMIN/DCS
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1265840094
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5660 TOWNSHIP ROAD 96
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKTOWN
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43019-8918
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-313-5206
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 OLENTANGY RIVER RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
COLUMBUS
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43212-3191
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
614-297-4757
Provider Business Practice Location Address Fax Number:
614-297-4759
Provider Enumeration Date:
07/24/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WA2000X , with the licence number:  RN 300359 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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