Provider Demographics
NPI:1750401063
Name:BARNES, JENNIFER N
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:N
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 1:1502 W JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MO
Mailing Address - Zip Code:63755-3010
Mailing Address - Country:US
Mailing Address - Phone:573-587-2520
Mailing Address - Fax:573-243-3413
Practice Address - Street 1:1502 W JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MO
Practice Address - Zip Code:63755-3010
Practice Address - Country:US
Practice Address - Phone:573-587-2520
Practice Address - Fax:573-243-3413
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2017-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004610225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO004610Medicaid