Healthcare Provider Details

I. General information

NPI: 1083070072
Provider Name (Legal Business Name): JEFFREY DAVID BARKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2016
Last Update Date: 01/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 S BECKHAM AVE
TYLER TX
75701-1908
US

IV. Provider business mailing address

1904 GOLDEN BAY
WHITEHOUSE TX
75791-5813
US

V. Phone/Fax

Practice location:
  • Phone: 903-597-0351
  • Fax:
Mailing address:
  • Phone: 903-312-8753
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP129966
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: