Provider Demographics
NPI:1669914545
Name:BARNES, CARLY VICTORIA (RN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:VICTORIA
Last Name:BARNES
Suffix:
Gender:F
Credentials:RN, FNP-BC
Other - Prefix:
Other - First Name:CARLY
Other - Middle Name:VICTORIA
Other - Last Name:BARNES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2 WORTH CIR STE 2
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37601-4306
Mailing Address - Country:US
Mailing Address - Phone:423-262-8006
Mailing Address - Fax:
Practice Address - Street 1:2103 FOREST DR STE 5
Practice Address - Street 2:
Practice Address - City:GRAY
Practice Address - State:TN
Practice Address - Zip Code:37615-8423
Practice Address - Country:US
Practice Address - Phone:423-794-3142
Practice Address - Fax:423-794-3184
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2024-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000026567363LF0000X
TNRN0000212538163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse