Provider Demographics
NPI:1780754994
Name:BARKER, KIMBERLY G (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:G
Last Name:BARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37771 SCHOENHERR RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2302
Mailing Address - Country:US
Mailing Address - Phone:586-274-2450
Mailing Address - Fax:586-274-2481
Practice Address - Street 1:37771 SCHOENHERR RD
Practice Address - Street 2:SUITE 101
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2302
Practice Address - Country:US
Practice Address - Phone:586-274-2450
Practice Address - Fax:586-274-2481
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002692363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06345Medicare ID - Type UnspecifiedCARDIOVASCULAR CONSULTANT