Provider Demographics
NPI:1588831051
Name:BARKER, DEWAYNE LYLE (BS)
Entity Type:Individual
Prefix:MR
First Name:DEWAYNE
Middle Name:LYLE
Last Name:BARKER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:DEWAYNE
Other - Middle Name:
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:BS
Mailing Address - Street 1:10802 QUAIL PLAZA DR STE 208
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-3121
Mailing Address - Country:US
Mailing Address - Phone:405-312-9882
Mailing Address - Fax:
Practice Address - Street 1:10802 QUAIL PLAZA DR STE 208
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-3121
Practice Address - Country:US
Practice Address - Phone:405-312-9882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator