Provider Demographics
NPI:1639794084
Name:BARKER- PRICE, KIMBERLY RAYE (APRN, AGPCNP)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:RAYE
Last Name:BARKER- PRICE
Suffix:
Gender:F
Credentials:APRN, AGPCNP
Other - Prefix:MS
Other - First Name:KIMBERLY
Other - Middle Name:RAYE
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1206 S 14TH AVE
Mailing Address - Street 2:
Mailing Address - City:MAYWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60153-1835
Mailing Address - Country:US
Mailing Address - Phone:773-441-3835
Mailing Address - Fax:
Practice Address - Street 1:1206 S 14TH AVE
Practice Address - Street 2:
Practice Address - City:MAYWOOD
Practice Address - State:IL
Practice Address - Zip Code:60153-1835
Practice Address - Country:US
Practice Address - Phone:773-441-3835
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-11
Last Update Date:2020-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209021386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner