Provider Demographics
NPI:1538465554
Name:BARNEY, KOMIMYISHEA S (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KOMIMYISHEA
Middle Name:S
Last Name:BARNEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KOMIMYISHEA
Other - Middle Name:S
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:161 WASHINGTON ST
Mailing Address - Street 2:8 TOWER BRIDGE SUITE 1400
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2083
Mailing Address - Country:US
Mailing Address - Phone:866-825-3227
Mailing Address - Fax:
Practice Address - Street 1:3920 HAMPTON AVE
Practice Address - Street 2:TAKE CARE CLINIC
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63109-1401
Practice Address - Country:US
Practice Address - Phone:866-825-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-09
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010041585363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily