Provider Demographics
NPI:1942920855
Name:BARKER, CASEY PADRAIC
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:PADRAIC
Last Name:BARKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MOULIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-4831
Mailing Address - Country:US
Mailing Address - Phone:209-288-8518
Mailing Address - Fax:
Practice Address - Street 1:1725 MOULIN AVE
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-4831
Practice Address - Country:US
Practice Address - Phone:209-288-8518
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-31
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704391303163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse