Healthcare Provider Details

I. General information

NPI: 1073252243
Provider Name (Legal Business Name): PRISCILLA BARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2022
Last Update Date: 11/09/2023
Certification Date: 11/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 E WILLIAMS FIELD RD STE 101
GILBERT AZ
85295-4880
US

IV. Provider business mailing address

920 E WILLIAMS FIELD RD STE 101
GILBERT AZ
85295-4880
US

V. Phone/Fax

Practice location:
  • Phone: 480-499-0201
  • Fax:
Mailing address:
  • Phone: 480-499-0201
  • Fax: 480-499-0203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9304
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: