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General NPI Number Information
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NPI Number | 1922204130
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Entity Type | Individual
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Provider Name | ANDREA KELLY BARKER M.D.
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Gender | Female
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 1340 BROAD AVE STE 220
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City | GULFPORT
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State | MS
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Zip | 39501-2465
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Country | US
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Telephone | 228-575-1300
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Fax | 228-867-6423
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Provider Business Mailing Address
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Address Line | PO BOX 1810
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City | GULFPORT
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State | MS
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Zip | 39502-1810
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Country | US
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Telephone | 228-575-1194
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Fax | 228-575-2917
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | T-1879
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 28021
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License Number State | NE
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Taxonomy #3
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Taxonomy Code | 2086S0129X
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Taxonomy Name | Vascular Surgery Physician
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License Number | 21286
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License Number State | MS
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