Provider Demographics
NPI:1336208008
Name:BARNES, SARAH L (RD, LD, CLC)
Entity Type:Individual
Prefix:MS
First Name:SARAH
Middle Name:L
Last Name:BARNES
Suffix:
Gender:F
Credentials:RD, LD, CLC
Other - Prefix:MS
Other - First Name:SARAH
Other - Middle Name:L
Other - Last Name:RYDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RD, LD
Mailing Address - Street 1:1141 DRAWBRIDGE CT
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37040-2513
Mailing Address - Country:US
Mailing Address - Phone:931-216-7223
Mailing Address - Fax:
Practice Address - Street 1:79 BASTOGNE AVE
Practice Address - Street 2:CYSS CACFP
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5520
Practice Address - Country:US
Practice Address - Phone:931-216-7223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2250133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered