Provider Demographics
NPI:1164805636
Name:BARNES, TERESSA LYNN (REGISTERED NURSE)
Entity Type:Individual
Prefix:MRS
First Name:TERESSA
Middle Name:LYNN
Last Name:BARNES
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 N. HUTCHINSON ST.
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602-4644
Mailing Address - Country:US
Mailing Address - Phone:870-247-7020
Mailing Address - Fax:
Practice Address - Street 1:810 N. HUTCHINSON ST.
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71602-4644
Practice Address - Country:US
Practice Address - Phone:870-247-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-02
Last Update Date:2015-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR077489163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR180635526Medicaid