MEDICARE: KELLY LYNN BARKLEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	4704246360	MI

General Provider Information

NPI Number	:	1568522688
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY LYNN BARKLEY NP

Provider Business Mailing Address
First Line	:	38807 ANN ARBOR RD STE 7
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150
Country	:	US
Telephone Number	:	734-953-6734
Fax Number	:	734-953-6738

Provider Business Practice Location Address
First Line	:	38807 ANN ARBOR RD STE 7
Second Line	:
City	:	LIVONIA
State	:	MI
Zip	:	48150
Country	:	US
Telephone Number	:	734-953-6734
Fax Number	:	734-953-6738

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2006
Last Update Date	:	05/09/2019

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