Healthcare Provider Details

I. General information

NPI: 1417177007
Provider Name (Legal Business Name): BERNICE ELEANORA BARNES ANP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BERNICE ELEANORA BARNES ANP-C

II. Dates (important events)

Enumeration Date: 04/26/2007
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4112 OUTLOOK BLVD STE 255
PUEBLO CO
81008-1667
US

IV. Provider business mailing address

6 KNIGHTSBRIDGE PL
PUEBLO CO
81001-1412
US

V. Phone/Fax

Practice location:
  • Phone: 719-562-6300
  • Fax: 719-562-6375
Mailing address:
  • Phone: 719-565-8219
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5452
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number59748
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: