Provider Demographics
NPI:1003903394
Name:FAULKNER, BARBARA (PA-C)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:FAULKNER
Suffix:
Gender:F
Credentials:PA-C
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 1908
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-1908
Mailing Address - Country:US
Mailing Address - Phone:903-455-5986
Mailing Address - Fax:903-454-4621
Practice Address - Street 1:8 EAST SIDE PLAZA
Practice Address - Street 2:
Practice Address - City:LADONIA
Practice Address - State:TX
Practice Address - Zip Code:75449
Practice Address - Country:US
Practice Address - Phone:903-367-7213
Practice Address - Fax:903-367-7215
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02653363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant