Provider Demographics
NPI:1205220696
Name:BARNES, ELIZABETH (PA-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:BARNES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 SOCIALVILLE-FOSTER RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:513-454-7246
Mailing Address - Fax:513-438-0202
Practice Address - Street 1:3611 SOCIALVILLE-FOSTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040
Practice Address - Country:US
Practice Address - Phone:513-454-7246
Practice Address - Fax:513-438-0202
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50004309208VP0000X
OH004309363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine