Provider Demographics
NPI:1417563867
Name:BARKLEY, KIRSTIN C
Entity Type:Individual
Prefix:MS
First Name:KIRSTIN
Middle Name:C
Last Name:BARKLEY
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 1:4037 STATE HIGHWAY 310
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:NY
Mailing Address - Zip Code:13667-3177
Mailing Address - Country:US
Mailing Address - Phone:315-771-1814
Mailing Address - Fax:
Practice Address - Street 1:4037 STATE HIGHWAY 310
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:NY
Practice Address - Zip Code:13667-3177
Practice Address - Country:US
Practice Address - Phone:315-771-1814
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-21
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY027742363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program