Healthcare Provider Details

I. General information

NPI: 1366949653
Provider Name (Legal Business Name): KELLY DIANE BARNES-NOVARRO B.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KELLY DIANE BARNES

II. Dates (important events)

Enumeration Date: 04/12/2018
Last Update Date: 04/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 N CHARLES G SEIVERS BLVD STE 101
CLINTON TN
37716-3944
US

IV. Provider business mailing address

6350 W ANDREW JOHNSON HWY
TALBOTT TN
37877-8605
US

V. Phone/Fax

Practice location:
  • Phone: 865-934-6150
  • Fax: 865-342-0150
Mailing address:
  • Phone: 800-355-3565
  • Fax: 423-714-2355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: