Provider Demographics
NPI:1134744287
Name:BARKER, JILLIAN G (PA-C)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:G
Last Name:BARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 N PLYMOUTH WAY
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92408-4121
Mailing Address - Country:US
Mailing Address - Phone:801-664-1760
Mailing Address - Fax:
Practice Address - Street 1:185 N PLYMOUTH WAY
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-4121
Practice Address - Country:US
Practice Address - Phone:801-664-1760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT904844801206363A00000X
390200000X
CAPA62565363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program