Provider Demographics
NPI:1134848534
Name:BARKLEY, KEELAN CORNELIUS
Entity type:Individual
Prefix:
First Name:KEELAN
Middle Name:CORNELIUS
Last Name:BARKLEY
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:PO BOX 6604
Mailing Address - Street 2:
Mailing Address - City:AMERICUS
Mailing Address - State:GA
Mailing Address - Zip Code:31709-6604
Mailing Address - Country:US
Mailing Address - Phone:229-938-1955
Mailing Address - Fax:
Practice Address - Street 1:111 OAKRIDGE DR
Practice Address - Street 2:
Practice Address - City:AMERICUS
Practice Address - State:GA
Practice Address - Zip Code:31709-5838
Practice Address - Country:US
Practice Address - Phone:229-938-1955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-26
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide