Provider Demographics
NPI:1295190312
Name:BARNES, KIMBERLY S
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1115 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2749
Mailing Address - Country:US
Mailing Address - Phone:270-769-5963
Mailing Address - Fax:270-769-9051
Practice Address - Street 1:4123 DUTCHMANS LN STE 601
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4725
Practice Address - Country:US
Practice Address - Phone:502-423-9595
Practice Address - Fax:502-719-0161
Is Sole Proprietor?:No
Enumeration Date:2015-12-16
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3009923367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife