Healthcare Provider Details

I. General information

NPI: 1861752404
Provider Name (Legal Business Name): MATTHEW BARKMAN PMHNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2012
Last Update Date: 05/09/2024
Certification Date: 05/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 790
PAGE AZ
86040-0790
US

IV. Provider business mailing address

PO BOX 790
PAGE AZ
86040-0790
US

V. Phone/Fax

Practice location:
  • Phone: 928-645-5113
  • Fax: 928-645-2364
Mailing address:
  • Phone: 928-645-5113
  • Fax: 928-645-2377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP4493
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: