MEDICARE: MRS. VANESSA NICOLE BARNES APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	213452	AR

General Provider Information

NPI Number	:	1194311498
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. VANESSA NICOLE BARNES APRN

Provider Business Mailing Address
First Line	:	3108 N WEST AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-2731
Country	:	US
Telephone Number	:	870-863-9020
Fax Number	:

Provider Business Practice Location Address
First Line	:	3108 N WEST AVE
Second Line	:
City	:	EL DORADO
State	:	AR
Zip	:	71730-2731
Country	:	US
Telephone Number	:	870-863-9020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2020
Last Update Date	:	12/21/2020

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