Provider Demographics
NPI:1306361159
Name:BARNES, ABBI RAE (RN)
Entity Type:Individual
Prefix:MRS
First Name:ABBI
Middle Name:RAE
Last Name:BARNES
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 E CRANDALL AVE
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-3628
Mailing Address - Country:US
Mailing Address - Phone:479-575-9471
Mailing Address - Fax:
Practice Address - Street 1:114 E CRANDALL AVE
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-3628
Practice Address - Country:US
Practice Address - Phone:479-575-9471
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR171M00000XMedicaid