Provider Demographics
NPI:1639240740
Name:BARKER, MIKKI (DO)
Entity Type:Individual
Prefix:DR
First Name:MIKKI
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16167
Mailing Address - Street 2:
Mailing Address - City:TWO RIVERS
Mailing Address - State:AK
Mailing Address - Zip Code:99716-0167
Mailing Address - Country:US
Mailing Address - Phone:907-322-9053
Mailing Address - Fax:
Practice Address - Street 1:225 WENDELL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-4835
Practice Address - Country:US
Practice Address - Phone:907-455-4135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-11
Last Update Date:2007-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKAK39212084P0800X
CA20A54882084P0800X
FL0065982084P0800X
IN02002028A2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
DO3395Medicare ID - Type Unspecified
E90711Medicare UPIN