Provider Demographics
NPI:1336373919
Name:BARKER, KELLY R (DO)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:R
Last Name:BARKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:10117 N. 92ND STREET
Mailing Address - Street 2:SUITE #101
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258
Mailing Address - Country:US
Mailing Address - Phone:480-614-5808
Mailing Address - Fax:480-614-5809
Practice Address - Street 1:10117 N. 92ND STREET
Practice Address - Street 2:SUITE #101
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258
Practice Address - Country:US
Practice Address - Phone:480-614-5808
Practice Address - Fax:480-614-5809
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2012-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AZ005997207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine