Provider Demographics
NPI:1023754694
Name:BARNETT, ROY ALAN
Entity type:Individual
Prefix:
First Name:ROY
Middle Name:ALAN
Last Name:BARNETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 SENIOR VILLAGE CIR
Mailing Address - Street 2:
Mailing Address - City:LA JUNTA
Mailing Address - State:CO
Mailing Address - Zip Code:81050-2656
Mailing Address - Country:US
Mailing Address - Phone:719-210-0554
Mailing Address - Fax:
Practice Address - Street 1:2317 SAN JUAN AVE
Practice Address - Street 2:
Practice Address - City:LA JUNTA
Practice Address - State:CO
Practice Address - Zip Code:81050-3340
Practice Address - Country:US
Practice Address - Phone:719-383-2325
Practice Address - Fax:719-383-2327
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-06
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
COPA.0007530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program