Healthcare Provider Details

I. General information

NPI: 1114911773
Provider Name (Legal Business Name): CHERYL BARNES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 10/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 TAYLORSVILLE RD SUITE 214
LOUISVILLE KY
40220
US

IV. Provider business mailing address

3703 TAYLORSVILLE RD SUITE 214
LOUISVILLE KY
40220-1354
US

V. Phone/Fax

Practice location:
  • Phone: 502-541-7661
  • Fax: 502-459-0629
Mailing address:
  • Phone: 502-478-1378
  • Fax: 502-458-2825

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number32968
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: