Provider Demographics
NPI:1316369275
Name:BARNES, SOPHIA L (CRNP)
Entity Type:Individual
Prefix:
First Name:SOPHIA
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1684
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35602-1684
Mailing Address - Country:US
Mailing Address - Phone:256-341-0152
Mailing Address - Fax:256-341-0587
Practice Address - Street 1:1222 SOMERVILLE RD SE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-4351
Practice Address - Country:US
Practice Address - Phone:256-341-0152
Practice Address - Fax:256-341-0587
Is Sole Proprietor?:No
Enumeration Date:2014-01-13
Last Update Date:2015-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-127529363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL167833Medicaid
AL167833Medicaid