Provider Demographics
NPI:1972783793
Name:BARNES, KASSIE JANETTE (CPNP)
Entity Type:Individual
Prefix:
First Name:KASSIE
Middle Name:JANETTE
Last Name:BARNES
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-2368
Mailing Address - Country:US
Mailing Address - Phone:931-528-1485
Mailing Address - Fax:931-526-4233
Practice Address - Street 1:108 4TH AVE S
Practice Address - Street 2:
Practice Address - City:BAXTER
Practice Address - State:TN
Practice Address - Zip Code:38544-5145
Practice Address - Country:US
Practice Address - Phone:931-255-4100
Practice Address - Fax:931-250-8925
Is Sole Proprietor?:No
Enumeration Date:2007-11-08
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12933363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN5440812Medicaid
TN151770Medicaid
TN1972783793OtherKASSIE BARNES NPI
TN5440812Medicaid
TN1538173471OtherCOOKEVILLE PEDIATRICS NPI