Basic Information
Provider Information
NPI: 1659827129
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARNHILL
FirstName: WILLIAM
MiddleName: BRANDON
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1103 KALISTE SALOOM RD
Address2: SUITE 304
City: LAFAYETTE
State: LA
PostalCode: 705085783
CountryCode: US
TelephoneNumber: 3379885646
FaxNumber:  
Practice Location
Address1: 1103 KALISTE SALOOM RD
Address2: SUITE 304
City: LAFAYETTE
State: LA
PostalCode: 705085783
CountryCode: US
TelephoneNumber: 3379885646
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/25/2016
LastUpdateDate: 01/29/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN0000194163TNN Nursing Service ProvidersRegistered Nurse 
163W00000X131855LAN Nursing Service ProvidersRegistered Nurse 
367500000XAP09044LAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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