Provider Demographics
NPI:1598823742
Name:BARNETT, MATHEW B (FNP C)
Entity Type:Individual
Prefix:
First Name:MATHEW
Middle Name:B
Last Name:BARNETT
Suffix:
Gender:M
Credentials:FNP C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 RIVER PARK PLACE W #440
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720
Mailing Address - Country:US
Mailing Address - Phone:559-256-5500
Mailing Address - Fax:559-256-5506
Practice Address - Street 1:30 RIVER PARK PLACE W #440
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720
Practice Address - Country:US
Practice Address - Phone:559-256-5500
Practice Address - Fax:559-256-5506
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF12740363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CANPF12740Medicaid
CANPF12740Medicaid
CANPF12740Medicare ID - Type Unspecified