Healthcare Provider Details

I. General information

NPI: 1083547459
Provider Name (Legal Business Name): JARED BARKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1320 SHARON RD
BENTON AR
72019-6118
US

IV. Provider business mailing address

1320 SHARON RD
BENTON AR
72019-6118
US

V. Phone/Fax

Practice location:
  • Phone: 501-249-6052
  • Fax: 501-249-6052
Mailing address:
  • Phone: 501-249-6052
  • Fax: 501-249-6052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number126068
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: