Provider Demographics
NPI:1689678534
Name:BARNES, JON C (FNP)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:C
Last Name:BARNES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8660 FERN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5657
Mailing Address - Country:US
Mailing Address - Phone:318-797-0009
Mailing Address - Fax:318-797-0092
Practice Address - Street 1:8660 FERN AVE STE 105
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5657
Practice Address - Country:US
Practice Address - Phone:318-797-0009
Practice Address - Fax:318-797-0092
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN073142363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1131831Medicaid
LA1053315846OtherGROUP NPI NUMBER
LA1131831Medicaid
LAP66637Medicare UPIN
LA4C3606742Medicare PIN
LA500028997OtherRAILROAD MEDICARE NUMBER
LA4C360Medicare PIN