Provider Demographics
NPI:1588966204
Name:BARNES, ELIZABETH ANNE (NP-C, APRN)
Entity type:Individual
Prefix:MISS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:BARNES
Suffix:
Gender:F
Credentials:NP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 CHEE DODGE BLVD
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6906
Mailing Address - Country:US
Mailing Address - Phone:620-331-8190
Mailing Address - Fax:888-334-6623
Practice Address - Street 1:610 N. 5TH STREET
Practice Address - Street 2:WESTERN NEW MEXICO MEDICAL GROUP-GALLUP
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301
Practice Address - Country:US
Practice Address - Phone:505-863-3828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-01
Last Update Date:2012-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS53-75287032363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily