Provider Demographics
NPI:1700034220
Name:BARNES, JEAN L (ENP)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:ENP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3419 PEACHSTONE PL
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-5111
Mailing Address - Country:US
Mailing Address - Phone:713-702-9732
Mailing Address - Fax:281-355-0677
Practice Address - Street 1:3419 PEACHSTONE PL
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77389-5111
Practice Address - Country:US
Practice Address - Phone:713-702-9732
Practice Address - Fax:281-355-0688
Is Sole Proprietor?:No
Enumeration Date:2008-09-09
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX617244363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1700034220OtherTRICARE SOUTH
TX1700034220OtherBCBSTX
TX8Y8948OtherBCBSTX
TX197972602Medicaid
TX197972603Medicaid
TX8L3918Medicare PIN
TX1700034220OtherBCBSTX
TXTXB119225Medicare PIN
TX1700034220Medicare PIN