Provider Demographics
NPI:1366019630
Name:BARKER, TERESA DARLENE
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:DARLENE
Last Name:BARKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 1/2 99TH ST
Mailing Address - Street 2:
Mailing Address - City:MARMET
Mailing Address - State:WV
Mailing Address - Zip Code:25315-1930
Mailing Address - Country:US
Mailing Address - Phone:304-541-8138
Mailing Address - Fax:
Practice Address - Street 1:204 1/2 99TH ST
Practice Address - Street 2:
Practice Address - City:MARMET
Practice Address - State:WV
Practice Address - Zip Code:25315-1930
Practice Address - Country:US
Practice Address - Phone:304-541-8138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant