Provider Demographics
NPI:1700806965
Name:BARNES-LIGHT, PATRICIA M (CNM NP)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:BARNES-LIGHT
Suffix:
Gender:F
Credentials:CNM NP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:875 OAK ST SE
Mailing Address - Street 2:SUITE 4090
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301-3985
Mailing Address - Country:US
Mailing Address - Phone:503-399-2444
Mailing Address - Fax:503-561-6878
Practice Address - Street 1:875 OAK ST SE
Practice Address - Street 2:SUITE 4090
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:503-399-2444
Practice Address - Fax:503-561-6878
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
367A00000X
OR200650048NP NP-PP367A00000X
OR200650048NP NMNP PP363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR213130Medicaid
OR135071Medicare ID - Type Unspecified
OR213130Medicaid