Healthcare Provider Details

I. General information

NPI: 1053610717
Provider Name (Legal Business Name): MOUNTAIN MEDICAL SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2011
Last Update Date: 06/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2946 WINFIELD DUNN PKWY STE 107
KODAK TN
37764-4306
US

IV. Provider business mailing address

2946 WINFIELD DUNN PKWY STE 107
KODAK TN
37764-4306
US

V. Phone/Fax

Practice location:
  • Phone: 865-933-9950
  • Fax: 865-465-3937
Mailing address:
  • Phone: 865-933-9950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN 13355
License Number StateTN

VIII. Authorized Official

Name: DR. ROGER DALE BARNES
Title or Position: DOCTOR
Credential: FNP DNP
Phone: 865-933-9950