Provider Demographics
NPI:1417071648
Name:BARNETT, KELLY B
Entity Type:Individual
Prefix:DR
First Name:KELLY
Middle Name:B
Last Name:BARNETT
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 1:3707 PLEASANT VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-8781
Mailing Address - Country:US
Mailing Address - Phone:417-725-2575
Mailing Address - Fax:
Practice Address - Street 1:1427 W STATE HIGHWAY J
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7473
Practice Address - Country:US
Practice Address - Phone:417-581-3600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO14242122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist