Basic Information
Provider Information | |||||||||
NPI: | 1447658851 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARKER | ||||||||
FirstName: | EMILY | ||||||||
MiddleName: |   | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | PMHNP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1100 BEECH ST BLDG 10 | ||||||||
Address2: |   | ||||||||
City: | NORMAL | ||||||||
State: | IL | ||||||||
PostalCode: | 617611493 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3094635800 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1100 BEECH ST. | ||||||||
Address2: | BUILDING 10, OFFICE 4 | ||||||||
City: | NORMAL | ||||||||
State: | IL | ||||||||
PostalCode: | 617611493 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3094635800 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/17/2014 | ||||||||
LastUpdateDate: | 12/22/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 12/22/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0808X | 041320633 | IL | N |   | Nursing Service Providers | Registered Nurse | Psych/Mental Health | 363LP0808X | 209024282 | IL | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.