Provider Demographics
NPI:1780080440
Name:BARNES, KIMBERLY DENISE
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DENISE
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 1:1320 10TH ST NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44703-3321
Mailing Address - Country:US
Mailing Address - Phone:330-265-4581
Mailing Address - Fax:
Practice Address - Street 1:1320 10TH ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44703-3321
Practice Address - Country:US
Practice Address - Phone:330-265-4581
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-07
Last Update Date:2020-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7609216OtherDODD
OH0108342Medicaid
OHCS1430700172OtherCARESOURCE