Healthcare Provider Details

I. General information

NPI: 1639794084
Provider Name (Legal Business Name): KIMBERLY RAYE BARKER- PRICE APRN, AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. KIMBERLY RAYE BARKER

II. Dates (important events)

Enumeration Date: 06/11/2020
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 W POLK ST
CHICAGO IL
60612-3723
US

IV. Provider business mailing address

422 S MAIN ST # 1082
LOMBARD IL
60148-2600
US

V. Phone/Fax

Practice location:
  • Phone: 312-864-6000
  • Fax:
Mailing address:
  • Phone: 708-540-3256
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number277.004826
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number277.004826
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: