MEDICARE: CHARLY BARKER NP-C

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	363LF0000X	Family Nurse Practitioner	11012996	FL

General Provider Information

NPI Number	:	1639740665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLY BARKER NP-C

Provider Business Mailing Address
First Line	:	2195 JENKS AVE STE B
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4683
Country	:	US
Telephone Number	:	850-784-6696
Fax Number	:

Provider Business Practice Location Address
First Line	:	2195 JENKS AVE
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-4682
Country	:	US
Telephone Number	:	850-784-6696
Fax Number	:

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

Provider Enumeration Date	:	07/09/2021
Last Update Date	:	02/03/2022

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