Provider Demographics
NPI:1952656423
Name:BARNES, AMBER ANN (NP-C)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ANN
Last Name:BARNES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 HANCOCK RD STE C
Mailing Address - Street 2:
Mailing Address - City:BULLHEAD CITY
Mailing Address - State:AZ
Mailing Address - Zip Code:86442-5961
Mailing Address - Country:US
Mailing Address - Phone:928-758-0121
Mailing Address - Fax:928-758-0145
Practice Address - Street 1:1225 HANCOCK RD STE C
Practice Address - Street 2:
Practice Address - City:BULLHEAD CITY
Practice Address - State:AZ
Practice Address - Zip Code:86442-5961
Practice Address - Country:US
Practice Address - Phone:928-758-0121
Practice Address - Fax:928-758-0145
Is Sole Proprietor?:No
Enumeration Date:2012-07-19
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP4562363LA2200X
UT5546584-4405363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ720698Medicaid