Healthcare Provider Details

I. General information

NPI: 1124845508
Provider Name (Legal Business Name): JOSHUAH C BARNES APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2024
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12050 12TH ST
EAGLEVILLE MO
64442-8158
US

IV. Provider business mailing address

1600 E EVERGREEN ST
CAMERON MO
64429-2400
US

V. Phone/Fax

Practice location:
  • Phone: 660-867-5414
  • Fax:
Mailing address:
  • Phone: 816-632-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2024040581
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: