Provider Demographics
NPI:1215115050
Name:BARNEY, PAULA FERN
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:FERN
Last Name:BARNEY
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 1:1573 E BARNEY LN
Mailing Address - Street 2:
Mailing Address - City:BENSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85602-7934
Mailing Address - Country:US
Mailing Address - Phone:520-586-2714
Mailing Address - Fax:
Practice Address - Street 1:1573 E BARNEY LN
Practice Address - Street 2:
Practice Address - City:BENSON
Practice Address - State:AZ
Practice Address - Zip Code:85602-7934
Practice Address - Country:US
Practice Address - Phone:520-586-2714
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-04
Last Update Date:2008-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ550086385HR2055X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2055XRespite Care FacilityRespite CareRespite Care, Mental Illness, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZE4374216OtherCONTRACT ID FOR GP HOME