Healthcare Provider Details

I. General information

NPI: 1285597427
Provider Name (Legal Business Name): VALARIE R BARNES
Entity Type: Individual
Gender:
Sole Proprietor: N

Provider Other Name: VALARIE RACHELLE

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

135 WILBUR JAMES RD
MANITOU KY
42436-9736
US

IV. Provider business mailing address

135 WILBUR JAMES RD
MANITOU KY
42436-9736
US

V. Phone/Fax

Practice location:
  • Phone: 270-231-5803
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number9F7BA1C4DA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: