Healthcare Provider Details

I. General information

NPI: 1588966204
Provider Name (Legal Business Name): ELIZABETH ANNE BARNES NP-C, APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2010
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N. 5TH STREET WESTERN NEW MEXICO MEDICAL GROUP-GALLUP
GALLUP NM
87301
US

IV. Provider business mailing address

3417 CHEE DODGE BLVD
GALLUP NM
87301-6906
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-3828
  • Fax:
Mailing address:
  • Phone: 620-331-8190
  • Fax: 888-334-6623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-75287032
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: