Provider Demographics
NPI:1629011358
Name:BARGER, DARIK SHANE (NP)
Entity Type:Individual
Prefix:MR
First Name:DARIK
Middle Name:SHANE
Last Name:BARGER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 N MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:ERWIN
Mailing Address - State:TN
Mailing Address - Zip Code:37650-1508
Mailing Address - Country:US
Mailing Address - Phone:423-560-6010
Mailing Address - Fax:423-560-6011
Practice Address - Street 1:1112 N MAIN AVE
Practice Address - Street 2:
Practice Address - City:ERWIN
Practice Address - State:TN
Practice Address - Zip Code:37650-1508
Practice Address - Country:US
Practice Address - Phone:423-560-6010
Practice Address - Fax:423-560-6011
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN104880363LF0000X
TN7172363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNDAV000Medicare UPIN
TN10350I4883Medicare PIN