Healthcare Provider Details

I. General information

NPI: 1831742147
Provider Name (Legal Business Name): CHRISTINA MARIE BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2019
Last Update Date: 12/02/2020
Certification Date: 12/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1453 E BERT KOUN LOOP STE 112
SHREVEPORT LA
71105-6810
US

IV. Provider business mailing address

PO BOX 51008
SHREVEPORT LA
71135-1008
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-9400
  • Fax:
Mailing address:
  • Phone: 318-798-9400
  • Fax: 318-424-0717

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number207257
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: