Provider Demographics
NPI:1043383375
Name:BARNES, JOHNNY KEITH JR (MSN-CRNA)
Entity Type:Individual
Prefix:MR
First Name:JOHNNY
Middle Name:KEITH
Last Name:BARNES
Suffix:JR
Gender:M
Credentials:MSN-CRNA
Other - Prefix:
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Mailing Address - Street 1:12752 KINGSTON PIKE
Mailing Address - Street 2:STE E202
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-0948
Mailing Address - Country:US
Mailing Address - Phone:865-777-0909
Mailing Address - Fax:865-777-0910
Practice Address - Street 1:550 FORT LOUDOUN MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5673
Practice Address - Country:US
Practice Address - Phone:865-777-0909
Practice Address - Fax:865-777-0910
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2011-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN104762163W00000X, 367500000X
TN11185367500000X
KY5249A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4277741OtherBLUE CROSS/BLUE SHIELD
TN1520646Medicaid