Provider Demographics
NPI:1013587625
Name:BARKER, KENNETH ONEIL II (CRNA)
Entity Type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:ONEIL
Last Name:BARKER
Suffix:II
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1195 SUMMERSET PL S
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-5156
Mailing Address - Country:US
Mailing Address - Phone:256-312-3760
Mailing Address - Fax:
Practice Address - Street 1:5400 FRED DR
Practice Address - Street 2:
Practice Address - City:SOUTHSIDE
Practice Address - State:AL
Practice Address - Zip Code:35907-5403
Practice Address - Country:US
Practice Address - Phone:256-312-3760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-26
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL390200000X
AL143747367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program