Basic Information
Provider Information
NPI: 1043551906
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARNFATHER
FirstName: NIKKI
MiddleName: CHARMAINE
NamePrefix: MS.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 8901 SE COMPASS ISLAND WAY
Address2:  
City: JUPITER
State: FL
PostalCode: 334581107
CountryCode: US
TelephoneNumber: 2252007419
FaxNumber:  
Practice Location
Address1: 4301 N FEDERAL HWY
Address2: SUITE 2
City: POMPANO BEACH
State: FL
PostalCode: 330646519
CountryCode: US
TelephoneNumber: 8888809270
FaxNumber: 9543420273
Other Information
ProviderEnumerationDate: 03/01/2013
LastUpdateDate: 03/01/2013
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
222Q00000X  Y Respiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist 

No ID Information.


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