Healthcare Provider Details

I. General information

NPI: 1659643666
Provider Name (Legal Business Name): HEATHER L BARNES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2012
Last Update Date: 10/21/2022
Certification Date: 10/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4935 E CHARLESTON BLVD
LAS VEGAS NV
89104-6402
US

IV. Provider business mailing address

4935 E CHARLESTON BLVD
LAS VEGAS NV
89104-6402
US

V. Phone/Fax

Practice location:
  • Phone: 702-483-8333
  • Fax:
Mailing address:
  • Phone: 702-483-8333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: