Provider Demographics
NPI:1114911773
Name:BARNES, CHERYL (MD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
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 1:3703 TAYLORSVILLE RD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-1354
Mailing Address - Country:US
Mailing Address - Phone:502-478-1378
Mailing Address - Fax:502-458-2825
Practice Address - Street 1:3703 TAYLORSVILLE RD
Practice Address - Street 2:SUITE 214
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220
Practice Address - Country:US
Practice Address - Phone:502-541-7661
Practice Address - Fax:502-459-0629
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32968208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64329683Medicaid
000000039733OtherANTHEM
1087732OtherPASSPORT
G87045Medicare UPIN
1087732OtherPASSPORT
010062572Medicare PIN