Provider Demographics
NPI:1548131485
Name:BARNES, VERONIKI JORDAN
Entity type:Individual
Prefix:
First Name:VERONIKI
Middle Name:JORDAN
Last Name:BARNES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:597 EASTERN DR UNIT 161
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38122-4050
Mailing Address - Country:US
Mailing Address - Phone:901-633-0191
Mailing Address - Fax:
Practice Address - Street 1:597 EASTERN DR UNIT 161
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38122-4050
Practice Address - Country:US
Practice Address - Phone:901-633-0191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-15
Last Update Date:2025-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN253Z00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities