MEDICARE: KIM MARIE BARNETT

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	347C00000X	Private Vehicle	RQ190633	OH
2	253Z00000X	In Home Supportive Care Agency	RQ190633	OH
3	347E00000X	Transportation Broker	RQ190633	OH
4	3747P1801X	Personal Care Attendant	RQ190633	OH

General Provider Information

NPI Number	:	1871348896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM MARIE BARNETT

Provider Business Mailing Address
First Line	:	738 CLARENDON RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1114
Country	:	US
Telephone Number	:	937-641-1294
Fax Number	:

Provider Business Practice Location Address
First Line	:	738 CLARENDON RD
Second Line	:
City	:	TROY
State	:	OH
Zip	:	45373-1114
Country	:	US
Telephone Number	:	937-641-1294
Fax Number	:

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

Provider Enumeration Date	:	04/22/2024
Last Update Date	:	04/22/2024

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Directions to “ KIM MARIE BARNETT ” Practice Location

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