Provider Demographics
NPI:1134472525
Name:BARKER, REBECCA RUBY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:RUBY
Last Name:BARKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:
Other - Last Name:KINDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:62 FORK CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NELLIS
Mailing Address - State:WV
Mailing Address - Zip Code:25142-9737
Mailing Address - Country:US
Mailing Address - Phone:304-833-0815
Mailing Address - Fax:304-833-0030
Practice Address - Street 1:62 FORK CREEK RD
Practice Address - Street 2:
Practice Address - City:NELLIS
Practice Address - State:WV
Practice Address - Zip Code:25142-9737
Practice Address - Country:US
Practice Address - Phone:304-833-0815
Practice Address - Fax:304-833-0030
Is Sole Proprietor?:No
Enumeration Date:2012-10-22
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV39056363LF0000X
WVAPRN39056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVJ960OtherGROUP MEDICARE
WVB441OtherGROUP MEDICARE
WVB441OtherGROUP MEDICARE
WVWV2681B441Medicare PIN