Provider Demographics
NPI:1083352090
Name:BARKER, KAYLEE MARIE
Entity Type:Individual
Prefix:
First Name:KAYLEE
Middle Name:MARIE
Last Name:BARKER
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 1:740 SW 109TH AVE APT 1909A
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33174-1372
Mailing Address - Country:US
Mailing Address - Phone:305-504-1124
Mailing Address - Fax:
Practice Address - Street 1:13300 SW 128TH ST FL 33186
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-5899
Practice Address - Country:US
Practice Address - Phone:786-250-3451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-20
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL1-24-70791103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician