Provider Demographics
NPI:1720058365
Name:BARKER, LAURA JO (PA-C, RD)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:JO
Last Name:BARKER
Suffix:
Gender:F
Credentials:PA-C, RD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:JO
Other - Last Name:PRUNTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1287 BURNS WAY
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3109
Mailing Address - Country:US
Mailing Address - Phone:406-752-8120
Mailing Address - Fax:406-752-8134
Practice Address - Street 1:1287 BURNS WAY
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3109
Practice Address - Country:US
Practice Address - Phone:406-752-8120
Practice Address - Fax:406-752-8134
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133V00000X, 363A00000X
MT34568363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered