Healthcare Provider Details

I. General information

NPI: 1992081491
Provider Name (Legal Business Name): JODY A BARHAM APN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2011
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2118 N STATE LINE AVE
TEXARKANA AR
71854-3583
US

IV. Provider business mailing address

2118 N STATE LINE AVE
TEXARKANA AR
71854-3583
US

V. Phone/Fax

Practice location:
  • Phone: 870-703-7764
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberA03610
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP135878
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: