Provider Demographics
NPI:1437812369
Name:BARNES, DERRICK TODD
Entity Type:Individual
Prefix:
First Name:DERRICK
Middle Name:TODD
Last Name:BARNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 RIDGELINE CIR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-4343
Mailing Address - Country:US
Mailing Address - Phone:346-366-6013
Mailing Address - Fax:
Practice Address - Street 1:5110 RIDGELINE CIR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4343
Practice Address - Country:US
Practice Address - Phone:346-366-6013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)