Healthcare Provider Details

I. General information

NPI: 1023971215
Provider Name (Legal Business Name): BARNES DIRECT PRIMARY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

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

3002 W JUNGE BLVD
JOPLIN MO
64801-3529
US

IV. Provider business mailing address

4925 S BROADWAY AVE 1116
WICHITA KS
67216-3716
US

V. Phone/Fax

Practice location:
  • Phone: 620-224-5950
  • Fax:
Mailing address:
  • Phone: 620-224-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BRETT ASHTON BARNES
Title or Position: MANAGER
Credential: FNP-BC, FNP-C
Phone: 620-224-5950