Healthcare Provider Details

I. General information

NPI: 1154684173
Provider Name (Legal Business Name): GARY C BARNETT M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2012
Last Update Date: 06/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 W INDIANA ST
EVANSVILLE IN
47712-5637
US

IV. Provider business mailing address

513 HARMONY WAY
EVANSVILLE IN
47712-7807
US

V. Phone/Fax

Practice location:
  • Phone: 812-428-0698
  • Fax: 812-429-9655
Mailing address:
  • Phone: 812-425-0006
  • Fax: 812-429-9655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: