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General NPI Number Information
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NPI Number | 1013587625
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Entity Type | Individual
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Provider Name | KENNETH ONEIL BARKER II CRNA
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Gender | Male
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Dates
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Enumeration Date | 06/26/2021
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Last Update Date | 05/05/2023
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Provider Practice Location Address
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Address Line | 5400 FRED DR
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City | SOUTHSIDE
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State | AL
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Zip | 35907-5403
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Country | US
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Telephone | 256-312-3760
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Fax |
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Provider Business Mailing Address
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Address Line | 1195 SUMMERSET PL S
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City | SOUTHSIDE
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State | AL
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Zip | 35907-5156
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Country | US
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Telephone | 256-312-3760
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 143747
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License Number State | AL
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