Provider Demographics
NPI:1952040164
Name:BARKER, JASON GLEN (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:GLEN
Last Name:BARKER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3601 COACH HOUSE CT
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23435-3207
Mailing Address - Country:US
Mailing Address - Phone:757-215-6870
Mailing Address - Fax:
Practice Address - Street 1:3601 COACH HOUSE CT
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23435-3207
Practice Address - Country:US
Practice Address - Phone:757-215-6870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-04
Last Update Date:2022-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024184425207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024184425OtherVIRGINIA BOARD OF NURSING