Healthcare Provider Details

I. General information

NPI: 1457098790
Provider Name (Legal Business Name): ROBERT WAYNE BARNETT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2022
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 W SHERMAN WAY STE 1
NIXA MO
65714-9022
US

IV. Provider business mailing address

116 W SHERMAN WAY STE 1
NIXA MO
65714-9022
US

V. Phone/Fax

Practice location:
  • Phone: 417-298-0984
  • Fax: 417-374-7185
Mailing address:
  • Phone: 417-298-0984
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-76561
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-216817
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: