Provider Demographics
NPI:1841563103
Name:BARNES, KELVIN GERARD (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:KELVIN
Middle Name:GERARD
Last Name:BARNES
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 402145
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2145
Mailing Address - Country:US
Mailing Address - Phone:803-434-2937
Mailing Address - Fax:803-296-7330
Practice Address - Street 1:3010 FARROW RD
Practice Address - Street 2:SUITE 300
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-7607
Practice Address - Country:US
Practice Address - Phone:803-434-2937
Practice Address - Fax:803-434-4331
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-17
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17627363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP2026Medicaid
SCNP2026Medicaid
SCAA88865770Medicare PIN