Provider Demographics
NPI:1952389462
Name:BARKETT, KENNETH J (MD)
Entity type:Individual
Prefix:
First Name:KENNETH
Middle Name:J
Last Name:BARKETT
Suffix:
Gender:M
Credentials:MD
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 801143
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-1143
Mailing Address - Country:US
Mailing Address - Phone:573-331-5583
Mailing Address - Fax:573-331-5079
Practice Address - Street 1:1012 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-5044
Practice Address - Country:US
Practice Address - Phone:573-431-0330
Practice Address - Fax:573-471-0461
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD36149207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201993300Medicaid
MO180015037OtherRAILROAD MEDICARE PART B
MO43074141063801A076OtherTRICARE NUMBER
MO25949OtherBCBS NUMBER
MO189287OtherHEALTHLINK NUMBER
MO1812734OtherFIRST HEALTH/CCN NUMBER
MO189287OtherHEALTHLINK NUMBER
MO25949OtherBCBS NUMBER