Provider Demographics
NPI: | 1043109846 |
---|---|
Name: | BARNETT, TELIMATHY |
Entity type: | Individual |
Prefix: | |
First Name: | TELIMATHY |
Middle Name: | |
Last Name: | BARNETT |
Suffix: | |
Gender: | M |
Credentials: | |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 44 A STOCKSTILL RD |
Mailing Address - Street 2: | |
Mailing Address - City: | PICAYUNE |
Mailing Address - State: | MS |
Mailing Address - Zip Code: | 39466-3619 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 769-242-2615 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 213 WILLIAMS AVE |
Practice Address - Street 2: | |
Practice Address - City: | PICAYUNE |
Practice Address - State: | MS |
Practice Address - Zip Code: | 39466-3944 |
Practice Address - Country: | US |
Practice Address - Phone: | 769-242-2615 |
Practice Address - Fax: | |
Is Sole Proprietor?: | Yes |
Enumeration Date: | 2025-06-28 |
Last Update Date: | 2025-06-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 310400000X | Nursing & Custodial Care Facilities | Assisted Living Facility | |
No | 3104A0625X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Mental Illness |
No | 3104A0630X | Nursing & Custodial Care Facilities | Assisted Living Facility | Assisted Living, Behavioral Disturbances |
No | 311Z00000X | Nursing & Custodial Care Facilities | Custodial Care Facility | |
No | 311ZA0620X | Nursing & Custodial Care Facilities | Custodial Care Facility | Adult Care Home |
No | 315D00000X | Nursing & Custodial Care Facilities | Hospice, Inpatient | |
No | 315P00000X | Nursing & Custodial Care Facilities | Intermediate Care Facility, Intellectual Disabilities | |
No | 320700000X | Residential Treatment Facilities | Residential Treatment Facility, Physical Disabilities | |
No | 320800000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Mental Illness | |
No | 320900000X | Residential Treatment Facilities | Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities |