Provider Demographics
NPI:1366866840
Name:BARNHART, CHARLENE GAYLE
Entity Type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:GAYLE
Last Name:BARNHART
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:POB 188
Mailing Address - Street 2:3426 WHEELER ROAD
Mailing Address - City:ST MARY OF THE WOODS
Mailing Address - State:IN
Mailing Address - Zip Code:47876-0188
Mailing Address - Country:US
Mailing Address - Phone:812-535-4500
Mailing Address - Fax:812-535-4500
Practice Address - Street 1:3426 WHEELER ROAD
Practice Address - Street 2:
Practice Address - City:ST MARY OF THE WOODS
Practice Address - State:IN
Practice Address - Zip Code:47876-0188
Practice Address - Country:US
Practice Address - Phone:812-535-4500
Practice Address - Fax:812-535-4500
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-05
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN3900171WH0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications