Healthcare Provider Details

I. General information

NPI: 1073209144
Provider Name (Legal Business Name): JENNIFER HELEN BARNES PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 10/29/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16100 NW CORNELL RD STE 220
BEAVERTON OR
97006-7334
US

IV. Provider business mailing address

65 SW YAMHILL ST STE 300
PORTLAND OR
97204-3316
US

V. Phone/Fax

Practice location:
  • Phone: 503-878-8885
  • Fax: 971-297-1360
Mailing address:
  • Phone: 503-878-8885
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number10006490
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number099000617RN
License Number StateOR
# 3
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License NumberL-14236
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: