Healthcare Provider Details

I. General information

NPI: 1619728029
Provider Name (Legal Business Name): MICHELLE LYNN BARNETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW PRYOR RD
LEES SUMMIT MO
64081-1104
US

IV. Provider business mailing address

202 SE CIRCLEVIEW DR
LEES SUMMIT MO
64063-6004
US

V. Phone/Fax

Practice location:
  • Phone: 816-519-2109
  • Fax:
Mailing address:
  • Phone: 816-519-2109
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License Number2020022307
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: