Healthcare Provider Details

I. General information

NPI: 1861481426
Provider Name (Legal Business Name): MICHAEL DEAN BARNES NP FNP BC MSN
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1106 N MAIN ST
SIKESTON MO
63801-5046
US

IV. Provider business mailing address

1106 N MAIN ST
SIKESTON MO
63801-5046
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-8656
  • Fax: 573-471-8491
Mailing address:
  • Phone: 573-471-8656
  • Fax: 573-471-8491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN153576
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: