Provider Demographics
NPI:1740296755
Name:BARKER, KATRINA (APRN)
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:
Last Name:BARKER
Suffix:
Gender:F
Credentials:APRN
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 550
Mailing Address - Street 2:
Mailing Address - City:VANCEBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41179-0550
Mailing Address - Country:US
Mailing Address - Phone:606-956-0162
Mailing Address - Fax:
Practice Address - Street 1:100 BELLEFONTE DR STE 2
Practice Address - Street 2:
Practice Address - City:GRAYSON
Practice Address - State:KY
Practice Address - Zip Code:41143-1820
Practice Address - Country:US
Practice Address - Phone:606-474-0669
Practice Address - Fax:606-474-4009
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003809363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100337420Medicaid
KYDV4908OtherRAILROAD
KYPO1446298OtherRAILROAD
KY78007960Medicaid
KYK180641Medicare PIN
KYDV4908OtherRAILROAD
500025882Medicare ID - Type UnspecifiedRAIL ROAD
KY0632930Medicare ID - Type Unspecified