Healthcare Provider Details

I. General information

NPI: 1447762000
Provider Name (Legal Business Name): LEX BARKER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2017
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11019 CANYON RD E STE A
PUYALLUP WA
98373
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 253-537-0293
  • Fax: 253-537-7650
Mailing address:
  • Phone: 253-537-0293
  • Fax: 253-537-7650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA60905843
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14447762000
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: