Provider Demographics
NPI:1629790126
Name:BARNES, BRETT ASHTON
Entity Type:Individual
Prefix:
First Name:BRETT
Middle Name:ASHTON
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 1:111 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-1229
Mailing Address - Country:US
Mailing Address - Phone:620-783-1358
Mailing Address - Fax:
Practice Address - Street 1:111 E 7TH ST
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-1229
Practice Address - Country:US
Practice Address - Phone:620-783-1358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-13
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95213019163W00000X
MO2019000743163W00000X
OH514494163W00000X
MO2022040629363LF0000X
KS53-81619-071363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse