Provider Demographics
NPI:1184024465
Name:BARKER, AUTUMN (MSAOM)
Entity Type:Individual
Prefix:
First Name:AUTUMN
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:MSAOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 EVERETT DR STE 200
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6315
Mailing Address - Country:US
Mailing Address - Phone:512-268-2768
Mailing Address - Fax:
Practice Address - Street 1:4100 EVERETT DR STE 200
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6315
Practice Address - Country:US
Practice Address - Phone:512-268-2768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-25
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01385171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist