MEDICARE: DR. KELLY B BARNETT

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	122300000X	Dentist	MO14242	MO

General Provider Information

NPI Number	:	1417071648
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELLY B BARNETT

Provider Business Mailing Address
First Line	:	3707 PLEASANT VALLEY DR
Second Line	:
City	:	NIXA
State	:	MO
Zip	:	65714-8781
Country	:	US
Telephone Number	:	417-725-2575
Fax Number	:

Provider Business Practice Location Address
First Line	:	1427 W STATE HIGHWAY J
Second Line	:
City	:	OZARK
State	:	MO
Zip	:	65721-7473
Country	:	US
Telephone Number	:	417-581-3600
Fax Number	:

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

Provider Enumeration Date	:	03/16/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. KELLY B BARNETT ” Practice Location

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