Provider Demographics
NPI:1275212094
Name:BARKER, KATIE LYN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYN
Last Name:BARKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:SC
Mailing Address - Zip Code:29693-1668
Mailing Address - Country:US
Mailing Address - Phone:864-647-1820
Mailing Address - Fax:864-236-4898
Practice Address - Street 1:111 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:SC
Practice Address - Zip Code:29693-1668
Practice Address - Country:US
Practice Address - Phone:864-647-1820
Practice Address - Fax:864-236-4898
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC011229347363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC27724OtherSC LICENSE