Provider Demographics
NPI:1720734056
Name:BARNES, NELLIE E
Entity Type:Individual
Prefix:
First Name:NELLIE
Middle Name:E
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 NW FOREST DR
Mailing Address - Street 2:
Mailing Address - City:WEATHERBY LAKE
Mailing Address - State:MO
Mailing Address - Zip Code:64152-1651
Mailing Address - Country:US
Mailing Address - Phone:816-217-6095
Mailing Address - Fax:
Practice Address - Street 1:19049 E VALLEY VIEW PKWY
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-7026
Practice Address - Country:US
Practice Address - Phone:816-795-8944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-24
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020018813225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant