Provider Demographics
NPI:1376598409
Name:BARNES-ELLIS, KAREN (APN)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:BARNES-ELLIS
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47713-1252
Mailing Address - Country:US
Mailing Address - Phone:812-421-7489
Mailing Address - Fax:812-436-0209
Practice Address - Street 1:25 W DIVISION ST
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1374
Practice Address - Country:US
Practice Address - Phone:812-436-4501
Practice Address - Fax:812-436-4510
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000074A363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000488313OtherANTHEM PIN
IN200079040DOtherMEDICAID GROUP
IN237890OtherMEDICARE GROUP
IN000000864712OtherBCBS
KY65945420OtherMEDICAID GROUP
IN200512220Medicaid
IN200829650DOtherMEDICAID GROUP
INP20111Medicare UPIN
IN637650006Medicare PIN
IN237890OtherMEDICARE GROUP