Basic Information
Provider Information
NPI: 1447546080
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARNARD
FirstName: ADAM
MiddleName: C
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 23229
Address2:  
City: OWENSBORO
State: KY
PostalCode: 423043229
CountryCode: US
TelephoneNumber: 2706881330
FaxNumber: 2706881338
Practice Location
Address1: 1301 PLEASANT VALLEY RD
Address2: SUITE 500B
City: OWENSBORO
State: KY
PostalCode: 423039774
CountryCode: US
TelephoneNumber: 2704177940
FaxNumber: 2704177949
Other Information
ProviderEnumerationDate: 06/22/2011
LastUpdateDate: 05/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 05/22/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  Y Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

ID Information
IDTypeStateIssuerDescription
710022958005KY MEDICAID


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