Basic Information
| Provider Information | |||||||||
| NPI: | 1740296755 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARKER | ||||||||
| FirstName: | KATRINA | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 550 | ||||||||
| Address2: | |||||||||
| City: | VANCEBURG | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411790550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6069560162 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 BELLEFONTE DR STE 2 | ||||||||
| Address2: | |||||||||
| City: | GRAYSON | ||||||||
| State: | KY | ||||||||
| PostalCode: | 411431820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6064740669 | ||||||||
| FaxNumber: | 6064744009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/31/2006 | ||||||||
| LastUpdateDate: | 11/18/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/18/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 3003809 | KY | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 7100337420 | 05 | KY | MEDICAID | DV4908 | 01 | KY | RAILROAD | OTHER | PO1446298 | 01 | KY | RAILROAD | OTHER | 78007960 | 05 | KY | MEDICAID |