Provider Demographics
NPI:1225017684
Name:BARNES, BRENDA KAY (DPM)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:KAY
Last Name:BARNES
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:BRENDA
Other - Middle Name:KAY
Other - Last Name:GRIDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPM
Mailing Address - Street 1:2227 19TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3608
Mailing Address - Country:US
Mailing Address - Phone:661-327-3205
Mailing Address - Fax:661-327-4532
Practice Address - Street 1:2227 19TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3608
Practice Address - Country:US
Practice Address - Phone:661-327-3205
Practice Address - Fax:661-327-4532
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3527213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E35270Medicaid
CA2555519OtherMEDI CAL PIN
CA2555519OtherMEDI CAL PIN
CA1045650001Medicare NSC
BB1023629OtherDEA