Healthcare Provider Details

I. General information

NPI: 1023754694
Provider Name (Legal Business Name): ROY ALAN BARNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2022
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2317 SAN JUAN AVE
LA JUNTA CO
81050-3340
US

IV. Provider business mailing address

1103 SENIOR VILLAGE CIR
LA JUNTA CO
81050-2656
US

V. Phone/Fax

Practice location:
  • Phone: 719-383-2325
  • Fax: 719-383-2327
Mailing address:
  • Phone: 719-210-0554
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0007530
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: