Provider Demographics
NPI:1861481426
Name:BARNES, MICHAEL DEAN (NP FNP BC MSN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DEAN
Last Name:BARNES
Suffix:
Gender:M
Credentials:NP FNP BC MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1106 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-5046
Mailing Address - Country:US
Mailing Address - Phone:573-471-8656
Mailing Address - Fax:573-471-8491
Practice Address - Street 1:1106 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5046
Practice Address - Country:US
Practice Address - Phone:573-471-8656
Practice Address - Fax:573-471-8491
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MORN153576363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
639247OtherHEALTHLINK
182686OtherBLUE CROSS
P00162719OtherRR MEDICARE
MORN153576OtherLICENSE
P00162719OtherRR MEDICARE