Provider Demographics
NPI:1689192494
Name:BARNUM, KYLE W (NP)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:W
Last Name:BARNUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 MEADOW POND CT STE 100
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9827
Mailing Address - Country:US
Mailing Address - Phone:614-663-4020
Mailing Address - Fax:601-663-4054
Practice Address - Street 1:3000 MEADOW POND CT STE 100
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:OH
Practice Address - Zip Code:43123-9827
Practice Address - Country:US
Practice Address - Phone:614-663-4020
Practice Address - Fax:614-663-4054
Is Sole Proprietor?:No
Enumeration Date:2017-08-31
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN.359151163W00000X
OHAPRN.CNP.021523363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse