Provider Demographics
NPI:1942559992
Name:BARNES, ANTHONY DAVID II
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:DAVID
Last Name:BARNES
Suffix:II
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 451236
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-1236
Mailing Address - Country:US
Mailing Address - Phone:321-236-2006
Mailing Address - Fax:321-250-7822
Practice Address - Street 1:1517 KELLEY AVE
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34744-3469
Practice Address - Country:US
Practice Address - Phone:321-236-2006
Practice Address - Fax:321-250-7822
Is Sole Proprietor?:No
Enumeration Date:2012-09-06
Last Update Date:2013-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171W00000XOther Service ProvidersContractor
No172A00000XOther Service ProvidersDriver
No172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL006489000Medicaid