Healthcare Provider Details

I. General information

NPI: 1043898422
Provider Name (Legal Business Name): EMILY NICOLE BARNES DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 01/04/2025
Certification Date: 01/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 E MONTCLAIR ST STE 100
SPRINGFIELD MO
65807-5068
US

IV. Provider business mailing address

929 E MONTCLAIR ST STE 100
SPRINGFIELD MO
65807-5068
US

V. Phone/Fax

Practice location:
  • Phone: 417-883-1881
  • Fax:
Mailing address:
  • Phone: 515-783-4601
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number2024015161
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: