Basic Information
| Provider Information | |||||||||
| NPI: | 1467727925 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | SHELLEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 44539 STERLING HWY | ||||||||
| Address2: | SUITE 206, | ||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072629400 | ||||||||
| FaxNumber: | 9072629422 | ||||||||
| Practice Location | |||||||||
| Address1: | 44539 STERLING HWY | ||||||||
| Address2: | SUITE 206, | ||||||||
| City: | SOLDOTNA | ||||||||
| State: | AK | ||||||||
| PostalCode: | 996697938 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9072629400 | ||||||||
| FaxNumber: | 9072629422 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2012 | ||||||||
| LastUpdateDate: | 03/16/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171M00000X | AK | Y | Other Service Providers | Case Manager/Care Coordinator |
ID Information
| ID | Type | State | Issuer | Description | CMG632 | 05 | AK | MEDICAID |