Provider Demographics
NPI:1003034281
Name:BARNES, KATRINA R (MD)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:R
Last Name:BARNES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 449
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-0449
Mailing Address - Country:US
Mailing Address - Phone:740-374-4500
Mailing Address - Fax:740-374-5887
Practice Address - Street 1:424 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:WV
Practice Address - Zip Code:26187-1249
Practice Address - Country:US
Practice Address - Phone:304-375-4656
Practice Address - Fax:740-375-2449
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2020-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35120427207Q00000X
WV22598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810020671Medicaid
OH0072600Medicaid
OH0072600Medicaid
OHH155541Medicare PIN
OHP01215976OtherRAILROAD MEDICARE
WV3810020671Medicaid