Provider Demographics
NPI:1417177007
Name:BARNES, BERNICE ELEANORA (ANP-C)
Entity Type:Individual
Prefix:
First Name:BERNICE
Middle Name:ELEANORA
Last Name:BARNES
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:MS
Other - First Name:BERNICE
Other - Middle Name:ELEANORA
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ANP-C
Mailing Address - Street 1:6 KNIGHTSBRIDGE PL
Mailing Address - Street 2:
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81001-1412
Mailing Address - Country:US
Mailing Address - Phone:719-565-8219
Mailing Address - Fax:
Practice Address - Street 1:4112 OUTLOOK BLVD STE 255
Practice Address - Street 2:
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81008-1667
Practice Address - Country:US
Practice Address - Phone:719-562-6300
Practice Address - Fax:719-562-6375
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO5452363LA2200X
CO59748364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist