Healthcare Provider Details

I. General information

NPI: 1861716524
Provider Name (Legal Business Name): LUCAS BENJAMIN BARKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2010
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 7149 BLACKSHEEP RUN RD
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

2020 21ST AVE S STE 201
NASHVILLE TN
37212-4354
US

V. Phone/Fax

Practice location:
  • Phone: 270-412-8688
  • Fax: 270-412-8421
Mailing address:
  • Phone: 615-269-0652
  • Fax: 615-269-0135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2088
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: