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General NPI Number Information
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NPI Number | 1558695601
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Entity Type | Organization
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Legal Business Name | KELLIE E BARNES DDS PLLC
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Dates
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Enumeration Date | 09/22/2009
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Last Update Date | 09/22/2009
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Provider Practice Location Address
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Address Line | 2646 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4435
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Country | US
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Telephone | 479-443-8009
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Fax | 479-443-4450
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Provider Business Mailing Address
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Address Line | 2646 E JOYCE BLVD STE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4435
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Country | US
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Telephone | 479-443-8009
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Fax | 479-443-4450
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Authorized Official
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Title or Position | OWNER
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Name | DR. KELLIE ELIZABETH BARNES
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Credential | DDS
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Telephone | 479-871-3801
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 3678
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License Number State | AR
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