Healthcare Provider Details

I. General information

NPI: 1144711441
Provider Name (Legal Business Name): EMILY LOGAN BARNES FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 SAM PERRY BLVD STE 211
FREDERICKSBURG VA
22401
US

IV. Provider business mailing address

1101 SAM PERRY BLVD STE 211
FREDERICKSBURG VA
22401-4465
US

V. Phone/Fax

Practice location:
  • Phone: 540-372-7792
  • Fax: 540-372-2073
Mailing address:
  • Phone: 540-372-7792
  • Fax: 540-372-2073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001251137
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024176167
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: