Provider Demographics
NPI:1578789731
Name:BARKER, NATASHA NICOLA (PAC)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:NICOLA
Last Name:BARKER
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:NATASHA
Other - Middle Name:NICOLA
Other - Last Name:COMEROSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PAC
Mailing Address - Street 1:118 12TH STREET EXT
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:WV
Mailing Address - Zip Code:24740-2352
Mailing Address - Country:US
Mailing Address - Phone:304-431-5168
Mailing Address - Fax:
Practice Address - Street 1:401 VERMILLION STREET
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:WV
Practice Address - Zip Code:24712
Practice Address - Country:US
Practice Address - Phone:304-384-7325
Practice Address - Fax:304-384-8870
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV00708363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q78515Medicare UPIN