Healthcare Provider Details

I. General information

NPI: 1497682082
Provider Name (Legal Business Name): CRAIG LAMONT BARNES JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12005 KATIE RIDGE RD
YUKON OK
73099-8955
US

IV. Provider business mailing address

12005 KATIE RIDGE RD
YUKON OK
73099-8955
US

V. Phone/Fax

Practice location:
  • Phone: 405-727-0704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: