Provider Demographics
NPI:1225030521
Name:BARNHART, JACQUELYN M (FNP-C)
Entity Type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:M
Last Name:BARNHART
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:JACQUELYN
Other - Middle Name:M
Other - Last Name:LINDSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 1359
Mailing Address - Street 2:
Mailing Address - City:ROCK SPRINGS
Mailing Address - State:WY
Mailing Address - Zip Code:82902-1359
Mailing Address - Country:US
Mailing Address - Phone:307-382-2234
Mailing Address - Fax:307-382-2302
Practice Address - Street 1:1180 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:ROCK SPRINGS
Practice Address - State:WY
Practice Address - Zip Code:82901-5863
Practice Address - Country:US
Practice Address - Phone:307-382-2234
Practice Address - Fax:307-382-2302
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR28258363LF0000X
WY43117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19793Medicaid
ND24856OtherBLUE CROSS BLUE SHIELD ND
ND19793Medicaid
NDN24856Medicare PIN