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General NPI Number Information
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NPI Number | 1568671766
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Entity Type | Organization
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Legal Business Name | WENDELL STREET PSYCHIATRIC LLC
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/08/2007
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Provider Practice Location Address
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Address Line | 225 WENDELL ST STE B
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City | FAIRBANKS
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State | AK
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Zip | 99701-4835
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Country | US
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Telephone | 907-455-4135
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Fax | 907-455-4115
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Provider Business Mailing Address
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Address Line | 225 WENDELL ST STE B
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City | FAIRBANKS
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State | AK
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Zip | 99701-4835
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Country | US
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Telephone | 907-455-4135
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Fax | 907-455-4115
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Authorized Official
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Title or Position | OWNER PRESIDENT
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Name | DR. MIKKI KING BARKER
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Credential | DO
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Telephone | 907-455-4135
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 3921
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License Number State | AK
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Taxonomy #2
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 3921
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License Number State | AK
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 3921
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License Number State | AK
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