Healthcare Provider Details

I. General information

NPI: 1487108841
Provider Name (Legal Business Name): ROBIN BARNES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN PHELPS PA-C

II. Dates (important events)

Enumeration Date: 08/15/2016
Last Update Date: 07/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 KENNERLY RD
SAINT LOUIS MO
63128
US

IV. Provider business mailing address

5350 PERSHING AVE UNIT 1A
SAINT LOUIS MO
63112-1779
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1000
  • Fax:
Mailing address:
  • Phone: 270-703-6273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number008808
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2016016638
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: