Healthcare Provider Details

I. General information

NPI: 1831789197
Provider Name (Legal Business Name): STACY KAYLA BARR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 WOODROW RD
MARLINTON WV
24954-6725
US

IV. Provider business mailing address

3873 MAPLE ACRES RD
BLUEFIELD WV
24701-5055
US

V. Phone/Fax

Practice location:
  • Phone: 304-799-2480
  • Fax:
Mailing address:
  • Phone: 304-324-8819
  • Fax: 304-324-8819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number93233
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: