Provider Demographics
NPI:1366904518
Name:BARNES, AMESHA
Entity type:Individual
Prefix:
First Name:AMESHA
Middle Name:
Last Name:BARNES
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1317 26TH AVE STE 306
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39501-1951
Mailing Address - Country:US
Mailing Address - Phone:228-343-3306
Mailing Address - Fax:
Practice Address - Street 1:1317 26TH AVE STE 306
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39501-1951
Practice Address - Country:US
Practice Address - Phone:228-343-3306
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2025-03-13
Deactivation Date:2021-08-11
Deactivation Code:
Reactivation Date:2021-09-02
Provider Licenses
StateLicense IDTaxonomies
372600000X
MSBP-04-2024-000913747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty