Provider Demographics
NPI:1528463379
Name:BARNES, BRIAN KYLE (PA-C)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:KYLE
Last Name:BARNES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3503 PAESANOS PKWY STE 201
Mailing Address - Street 2:
Mailing Address - City:SHAVANO PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78231-1225
Mailing Address - Country:US
Mailing Address - Phone:210-504-3650
Mailing Address - Fax:210-519-3045
Practice Address - Street 1:3503 PAESANOS PKWY STE 201
Practice Address - Street 2:
Practice Address - City:SHAVANO PARK
Practice Address - State:TX
Practice Address - Zip Code:78231-1225
Practice Address - Country:US
Practice Address - Phone:210-504-3650
Practice Address - Fax:210-519-3045
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-22
Last Update Date:2025-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ5904363A00000X
SC5814363A00000X
TXPA13355363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA13355OtherTEXAS MEDICAL BOARD
SC5814OtherSCLLR