Healthcare Provider Details

I. General information

NPI: 1003073800
Provider Name (Legal Business Name): KAMESHA JENNEL BARNES CPN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KAMESHA JENNEL BASZILE CPN, FNP-C

II. Dates (important events)

Enumeration Date: 05/20/2008
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1276 S PEACHTREE ST
JASPER TX
75951
US

IV. Provider business mailing address

1276 S PEACHTREE ST
JASPER TX
75951-4916
US

V. Phone/Fax

Practice location:
  • Phone: 409-384-5701
  • Fax:
Mailing address:
  • Phone: 409-384-5701
  • Fax: 409-384-4238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number675801
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: