Provider Demographics
NPI:1659104487
Name:BARNES, JESSICA RUTH (NP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:RUTH
Last Name:BARNES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1917
Mailing Address - Street 2:
Mailing Address - City:CLOUDCROFT
Mailing Address - State:NM
Mailing Address - Zip Code:88317-1917
Mailing Address - Country:US
Mailing Address - Phone:575-725-0579
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 1917
Practice Address - Street 2:
Practice Address - City:CLOUDCROFT
Practice Address - State:NM
Practice Address - Zip Code:88317-1917
Practice Address - Country:US
Practice Address - Phone:575-725-0579
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-26
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80575363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily