Provider Demographics
NPI:1578071437
Name:BARNER SMITH, TINA
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:BARNER SMITH
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 1:224 BEDFORD ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:KS
Mailing Address - Zip Code:66030-1186
Mailing Address - Country:US
Mailing Address - Phone:708-495-3620
Mailing Address - Fax:
Practice Address - Street 1:14670 S HARRISON ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7224
Practice Address - Country:US
Practice Address - Phone:913-938-4786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-12
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-T-00101225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS18-T-00101Medicaid
KS18-T-00101OtherBCBS