Healthcare Provider Details

I. General information

NPI: 1972783793
Provider Name (Legal Business Name): KASSIE JANETTE BARNES CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2007
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 4TH AVE S
BAXTER TN
38544-5145
US

IV. Provider business mailing address

150 N WILLOW AVE
COOKEVILLE TN
38501-2368
US

V. Phone/Fax

Practice location:
  • Phone: 931-255-4100
  • Fax: 931-250-8925
Mailing address:
  • Phone: 931-528-1485
  • Fax: 931-526-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number12933
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: