Provider Demographics
NPI:1093490013
Name:BARNES, KAYLA A
Entity Type:Individual
Prefix:
First Name:KAYLA
Middle Name:A
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12220 FERRIN RD
Mailing Address - Street 2:
Mailing Address - City:CARLYLE
Mailing Address - State:IL
Mailing Address - Zip Code:62231-3804
Mailing Address - Country:US
Mailing Address - Phone:618-973-6350
Mailing Address - Fax:
Practice Address - Street 1:12220 FERRIN RD
Practice Address - Street 2:
Practice Address - City:CARLYLE
Practice Address - State:IL
Practice Address - Zip Code:62231-3804
Practice Address - Country:US
Practice Address - Phone:618-973-6350
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-19
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered