Healthcare Provider Details

I. General information

NPI: 1316633662
Provider Name (Legal Business Name): ALLYSON NICOLE BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2023
Last Update Date: 10/07/2026
Certification Date: 10/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

410 TEACO RD
KENNETT MO
63857-3239
US

IV. Provider business mailing address

139 BROOKLAND ST APT 4
BROOKLAND AR
72417-9048
US

V. Phone/Fax

Practice location:
  • Phone: 870-316-4033
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: