Healthcare Provider Details

I. General information

NPI: 1093762478
Provider Name (Legal Business Name): MR. KEVIN PETER BARSNESS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 01/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27040 COUNTY ROAD 9
BEMIDJI MN
56601-5456
US

IV. Provider business mailing address

24616 CAP ENDRES RD NE
CASS LAKE MN
56633-3386
US

V. Phone/Fax

Practice location:
  • Phone: 218-751-6405
  • Fax:
Mailing address:
  • Phone: 218-335-0128
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberR1075319
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR1075319
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: