Provider Demographics
NPI:1336691468
Name:BARKER, JESSICA (RN)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:
Other - Last Name:HENNING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5111 W NATIONAL AVE APT 3
Mailing Address - Street 2:
Mailing Address - City:WEST MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3550
Mailing Address - Country:US
Mailing Address - Phone:920-210-4187
Mailing Address - Fax:
Practice Address - Street 1:5111 W NATIONAL AVE APT 3
Practice Address - Street 2:
Practice Address - City:WEST MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53214-3550
Practice Address - Country:US
Practice Address - Phone:920-210-4187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-24
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI165256-30163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse