Provider Demographics
NPI:1932132875
Name:BARKS, TAMMERA J
Entity Type:Individual
Prefix:MRS
First Name:TAMMERA
Middle Name:J
Last Name:BARKS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2614 RIDGEWOOD PL
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-1543
Mailing Address - Country:US
Mailing Address - Phone:417-256-0683
Mailing Address - Fax:
Practice Address - Street 1:1480 8TH ST
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-2010
Practice Address - Country:US
Practice Address - Phone:417-256-5669
Practice Address - Fax:417-256-5699
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO116745225200000X
AR1248225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant