Basic Information
| Provider Information | |||||||||
| NPI: | 1013931732 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | JAMMIE | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | RN MSN ARNP FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2010 BILL OWENS PKWY | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756046210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032473400 | ||||||||
| FaxNumber: | 9032389183 | ||||||||
| Practice Location | |||||||||
| Address1: | 2010 BILL OWENS PKWY | ||||||||
| Address2: | |||||||||
| City: | LONGVIEW | ||||||||
| State: | TX | ||||||||
| PostalCode: | 756046210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9032473400 | ||||||||
| FaxNumber: | 9032389183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2006 | ||||||||
| LastUpdateDate: | 06/14/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 46651 | OK | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 559894 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 243603001 | 05 | OK | MEDICAID |