Provider Demographics
NPI:1073641635
Name:BARNES, STARLA JO (PSC,BA)
Entity Type:Individual
Prefix:MRS
First Name:STARLA
Middle Name:JO
Last Name:BARNES
Suffix:
Gender:F
Credentials:PSC,BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:213 ANDOVER DR
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:KY
Mailing Address - Zip Code:42740-8728
Mailing Address - Country:US
Mailing Address - Phone:270-369-9041
Mailing Address - Fax:270-369-0071
Practice Address - Street 1:213 ANDOVER DR
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:KY
Practice Address - Zip Code:42740-8728
Practice Address - Country:US
Practice Address - Phone:270-369-9041
Practice Address - Fax:270-369-0071
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01806OtherFIRST STEPS PROVIDER NUMB