Provider Demographics
NPI:1851799092
Name:BARLEY, KARA EMILY (PA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:EMILY
Last Name:BARLEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:E
Other - Last Name:HINES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:3120 RIVERSIDE AVE
Mailing Address - Street 2:GATEB BUILDING 1
Mailing Address - City:MARINETTE
Mailing Address - State:WI
Mailing Address - Zip Code:54143-6007
Mailing Address - Country:US
Mailing Address - Phone:715-732-2075
Mailing Address - Fax:715-732-2092
Practice Address - Street 1:3120 RIVERSIDE AVE
Practice Address - Street 2:GATEB BUILDING 1
Practice Address - City:MARINETTE
Practice Address - State:WI
Practice Address - Zip Code:54143-6007
Practice Address - Country:US
Practice Address - Phone:715-732-2075
Practice Address - Fax:715-732-2092
Is Sole Proprietor?:No
Enumeration Date:2014-12-19
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3460-23363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400192516Medicare Oscar/Certification
WIK400192517Medicare Oscar/Certification
WIK400192515Medicare Oscar/Certification