Provider Demographics
NPI:1912304031
Name:BARNES, MATTHEW
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:BARNES
Suffix:
Gender:M
Credentials:
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 40480
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36640-0480
Mailing Address - Country:US
Mailing Address - Phone:251-660-5108
Mailing Address - Fax:251-660-5792
Practice Address - Street 1:3301 KNOLLWOOD DR
Practice Address - Street 2:FOUR MED PK
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36693-7003
Practice Address - Country:US
Practice Address - Phone:251-660-5108
Practice Address - Fax:251-660-5792
Is Sole Proprietor?:No
Enumeration Date:2014-12-04
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-134334163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse