Provider Demographics
NPI:1083290951
Name:BARKER, RAVEN ELISE
Entity Type:Individual
Prefix:
First Name:RAVEN
Middle Name:ELISE
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RAVEN
Other - Middle Name:ELISE
Other - Last Name:GIBSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:301 ANDREWS AVE
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:46933
Mailing Address - Country:US
Mailing Address - Phone:334-255-7000
Mailing Address - Fax:
Practice Address - Street 1:301 ANDREWS AVE
Practice Address - Street 2:
Practice Address - City:FORT RUCKER
Practice Address - State:AL
Practice Address - Zip Code:46933
Practice Address - Country:US
Practice Address - Phone:334-255-7000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-22
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider