Healthcare Provider Details

I. General information

NPI: 1093661209
Provider Name (Legal Business Name): KACIE BARNES
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8661 CERCLE CHATEAUX RAE
SEMINOLE FL
33777-2547
US

IV. Provider business mailing address

4604 49TH ST N # 1132
ST PETERSBURG FL
33709-3842
US

V. Phone/Fax

Practice location:
  • Phone: 727-819-4977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSA16201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: