Provider Demographics
NPI:1376557900
Name:BARKER, MARY MYRA (APRN, BC)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MYRA
Last Name:BARKER
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:748 BATTLEFIELD BLVD N
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-4941
Mailing Address - Country:US
Mailing Address - Phone:757-382-8637
Mailing Address - Fax:757-828-6513
Practice Address - Street 1:748 BATTLEFIELD BLVD N
Practice Address - Street 2:
Practice Address - City:CHESAPEAKE
Practice Address - State:VA
Practice Address - Zip Code:23320-4941
Practice Address - Country:US
Practice Address - Phone:757-382-8637
Practice Address - Fax:757-382-8651
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024112533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP92437Medicare UPIN