Healthcare Provider Details

I. General information

NPI: 1598968356
Provider Name (Legal Business Name): JESSICA LYNN BARNETTE REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W 5TH ST 550
SANTA ANA CA
92701-4519
US

IV. Provider business mailing address

212 VILLANOVA RD
COSTA MESA CA
92626-6363
US

V. Phone/Fax

Practice location:
  • Phone: 714-834-4707
  • Fax:
Mailing address:
  • Phone: 714-437-9196
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number645390
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: