1700034220 NPI number — JEAN L BARNES ENP

Table of content: JEAN L BARNES ENP (NPI 1700034220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700034220 NPI number — JEAN L BARNES ENP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARNES
Provider First Name:
JEAN
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ENP
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:
1700034220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3419 PEACHSTONE PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77389-5111
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-702-9732
Provider Business Mailing Address Fax Number:
281-355-0677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3419 PEACHSTONE PL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77389-5111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-702-9732
Provider Business Practice Location Address Fax Number:
281-355-0688
Provider Enumeration Date:
09/09/2008

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: 363LF0000X , with the licence number:  617244 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 617244 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1700034220 . This is a "TRICARE SOUTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1700034220 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8Y8948 . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 197972602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197972603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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