Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 1-150679 | AL |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 1-150679 | AL |
NPI | 1003477092 |
---|---|
Provider Name | Mrs. Katelyn Perry Barnes |
First Address | Montgomery, AL 36117-7104 |
Second Address | Montgomery, AL 36117-7104 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/06/2019 |
Last Update Date | 03/03/2020 |