Healthcare Provider Details

I. General information

NPI: 1104792126
Provider Name (Legal Business Name): ANNA BARKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/15/2025
Last Update Date: 10/24/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

72 FRANKLIN AVE APT 1
SARANAC LAKE NY
12983-2062
US

IV. Provider business mailing address

72 FRANKLIN AVE APT 1
SARANAC LAKE NY
12983-2062
US

V. Phone/Fax

Practice location:
  • Phone: 518-354-3956
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number407572
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: