Healthcare Provider Details

I. General information

NPI: 1669914545
Provider Name (Legal Business Name): CARLY VICTORIA BARNES RN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CARLY VICTORIA BARNES RN

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 12/13/2024
Certification Date: 12/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2103 FOREST DR STE 5
GRAY TN
37615-8423
US

IV. Provider business mailing address

2 WORTH CIR STE 2
JOHNSON CITY TN
37601-4306
US

V. Phone/Fax

Practice location:
  • Phone: 423-794-3142
  • Fax: 423-794-3184
Mailing address:
  • Phone: 423-262-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0000026567
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN0000212538
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: