Healthcare Provider Details

I. General information

NPI: 1124790449
Provider Name (Legal Business Name): MICHELLE BARNES CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2021
Last Update Date: 08/28/2023
Certification Date: 08/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1451 BELLE HAVEN RD STE 110
ALEXANDRIA VA
22307-1201
US

IV. Provider business mailing address

1451 BELLE HAVEN RD STE 110
ALEXANDRIA VA
22307-1201
US

V. Phone/Fax

Practice location:
  • Phone: 703-765-6093
  • Fax:
Mailing address:
  • Phone: 703-765-6093
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number5015161
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberBARN-BK5PT
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024187431
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: