Provider Demographics
NPI:1205544673
Name:BARNES, COURTENIE RUTH
Entity type:Individual
Prefix:
First Name:COURTENIE
Middle Name:RUTH
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:COURTENIE
Other - Middle Name:RUTH
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:609 TRAUB PL
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-2737
Mailing Address - Country:US
Mailing Address - Phone:405-514-9647
Mailing Address - Fax:
Practice Address - Street 1:609 TRAUB PL
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-2737
Practice Address - Country:US
Practice Address - Phone:405-514-9647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator