Healthcare Provider Details

I. General information

NPI: 1538392691
Provider Name (Legal Business Name): PHILLIP D BARNES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 01/04/2024
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

252 W 9TH ST STE A
HOISINGTON KS
67544-1700
US

IV. Provider business mailing address

250 W 9TH ST
HOISINGTON KS
67544-1706
US

V. Phone/Fax

Practice location:
  • Phone: 620-653-2386
  • Fax: 620-653-4186
Mailing address:
  • Phone: 620-653-5067
  • Fax: 620-653-5070

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number15-01344
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: