MEDICARE: MRS. STARLA JO BARNES PSC,BA

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	171M00000X	Case Manager/Care Coordinator

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	01806	OTHER	KY	FIRST STEPS PROVIDER NUMB

General Provider Information

NPI Number	:	1073641635
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. STARLA JO BARNES PSC,BA

Provider Business Mailing Address
First Line	:	213 ANDOVER DR
Second Line	:
City	:	GLENDALE
State	:	KY
Zip	:	42740-8728
Country	:	US
Telephone Number	:	270-369-9041
Fax Number	:	270-369-0071

Provider Business Practice Location Address
First Line	:	213 ANDOVER DR
Second Line	:
City	:	GLENDALE
State	:	KY
Zip	:	42740-8728
Country	:	US
Telephone Number	:	270-369-9041
Fax Number	:	270-369-0071

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	07/08/2007

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