Provider Demographics
NPI:1467727925
Name:BARKER, SHELLEY
Entity Type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:
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 1:44539 STERLING HWY
Mailing Address - Street 2:SUITE 206,
Mailing Address - City:SOLDOTNA
Mailing Address - State:AK
Mailing Address - Zip Code:99669-7938
Mailing Address - Country:US
Mailing Address - Phone:907-262-9400
Mailing Address - Fax:907-262-9422
Practice Address - Street 1:44539 STERLING HWY
Practice Address - Street 2:SUITE 206,
Practice Address - City:SOLDOTNA
Practice Address - State:AK
Practice Address - Zip Code:99669-7938
Practice Address - Country:US
Practice Address - Phone:907-262-9400
Practice Address - Fax:907-262-9422
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKCMG632Medicaid