MEDICARE: BARNES DIRECT PRIMARY CARE LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1023971215
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARNES DIRECT PRIMARY CARE LLC

Provider Business Mailing Address
First Line	:	4925 S BROADWAY AVE
Second Line	:	1116
City	:	WICHITA
State	:	KS
Zip	:	67216-3716
Country	:	US
Telephone Number	:	620-224-5950
Fax Number	:

Provider Business Practice Location Address
First Line	:	3002 W JUNGE BLVD
Second Line	:
City	:	JOPLIN
State	:	MO
Zip	:	64801-3529
Country	:	US
Telephone Number	:	620-224-5950
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BRETT ASHTON BARNES
Credential	:	FNP-BC, FNP-C
Telephone Number	:	620-224-5950

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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