Provider Demographics
NPI:1134239130
Name:BARKI, KELLY H (DO)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:H
Last Name:BARKI
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:RD #4 BOX 19 WILSON DRIVE
Mailing Address - Street 2:
Mailing Address - City:CAMERON
Mailing Address - State:WV
Mailing Address - Zip Code:26033-9520
Mailing Address - Country:US
Mailing Address - Phone:304-686-3376
Mailing Address - Fax:304-686-3646
Practice Address - Street 1:RD #4 19 WILSON DRIVE
Practice Address - Street 2:CAMERON COMMUNITY HEALTH CENTER INC
Practice Address - City:CAMERON
Practice Address - State:WV
Practice Address - Zip Code:26033-9520
Practice Address - Country:US
Practice Address - Phone:304-686-3376
Practice Address - Fax:304-686-3646
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1990207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001719909OtherBCBS
WV1842115000Medicaid
H89581Medicare UPIN
WV001719909OtherBCBS
BA4112491Medicare PIN