Provider Demographics
NPI:1336321058
Name:BARNES, THEA A (LPN)
Entity Type:Individual
Prefix:MRS
First Name:THEA
Middle Name:A
Last Name:BARNES
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:935 MCALLISTER ST
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:38701-5808
Mailing Address - Country:US
Mailing Address - Phone:662-378-3423
Mailing Address - Fax:662-378-3423
Practice Address - Street 1:935 MCALLISTER ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38701-5808
Practice Address - Country:US
Practice Address - Phone:662-378-3423
Practice Address - Fax:662-378-3423
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSP279862164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS770324015Medicaid