Provider Demographics
NPI:1669053765
Name:BARKLEY, MARY MARGARET (FNP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3573 SPRINGWHEAT
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61114-5628
Mailing Address - Country:US
Mailing Address - Phone:815-289-3100
Mailing Address - Fax:
Practice Address - Street 1:3573 SPRINGWHEAT
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61114-5628
Practice Address - Country:US
Practice Address - Phone:815-289-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-20
Last Update Date:2021-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAF01210286363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily