Healthcare Provider Details

I. General information

NPI: 1407999683
Provider Name (Legal Business Name): MISTY C BARKER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

768 EVERETT ST
TIPTONVILLE TN
38079-1608
US

IV. Provider business mailing address

PO BOX 108
TIPTONVILLE TN
38079-0108
US

V. Phone/Fax

Practice location:
  • Phone: 731-253-3760
  • Fax:
Mailing address:
  • Phone: 731-571-0569
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number13954
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13954
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: