Provider Demographics
NPI:1942869532
Name:BARNES, KELSEY L
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:
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 513
Mailing Address - Street 2:
Mailing Address - City:LINGLE
Mailing Address - State:WY
Mailing Address - Zip Code:82223-0513
Mailing Address - Country:US
Mailing Address - Phone:307-575-0739
Mailing Address - Fax:
Practice Address - Street 1:1757 W C ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:WY
Practice Address - Zip Code:82240-3215
Practice Address - Country:US
Practice Address - Phone:307-575-0739
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator