Provider Demographics
NPI:1093108953
Name:BARKER, PEGGY (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:PEGGY
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:REGISTERED NURSE
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 497
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:AR
Mailing Address - Zip Code:72006-0497
Mailing Address - Country:US
Mailing Address - Phone:870-347-2534
Mailing Address - Fax:870-347-3492
Practice Address - Street 1:801 N 9TH ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:AR
Practice Address - Zip Code:72006-2133
Practice Address - Country:US
Practice Address - Phone:870-347-3428
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR033107163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator