Healthcare Provider Details

I. General information

NPI: 1699306241
Provider Name (Legal Business Name): AMBER BARNEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2020
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3611 S LAFOUNTAIN ST
KOKOMO IN
46902
US

IV. Provider business mailing address

10845 GRIFFITH PEAK DR # 2
LAS VEGAS NV
89135-1553
US

V. Phone/Fax

Practice location:
  • Phone: 765-776-3700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number71009957A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: