Provider Demographics
NPI:1295496123
Name:BARNETT, JACOB
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
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 1:300 COUNTY ROAD 34440
Mailing Address - Street 2:
Mailing Address - City:SUMNER
Mailing Address - State:TX
Mailing Address - Zip Code:75486-5067
Mailing Address - Country:US
Mailing Address - Phone:903-517-8939
Mailing Address - Fax:
Practice Address - Street 1:300 COUNTY ROAD 34440
Practice Address - Street 2:
Practice Address - City:SUMNER
Practice Address - State:TX
Practice Address - Zip Code:75486-5067
Practice Address - Country:US
Practice Address - Phone:903-517-8939
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic TrainerGroup - Single Specialty
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program