MEDICARE: MRS. KIMBERLY RAYE BARKER- PRICE APRN, AGPCNP

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	363LG0600X	Gerontology Nurse Practitioner	277.004826	IL
2	363L00000X	Nurse Practitioner	277.004826	IL

General Provider Information

NPI Number	:	1639794084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KIMBERLY RAYE BARKER- PRICE APRN, AGPCNP

Provider Business Mailing Address
First Line	:	1206 S 14TH AVE
Second Line	:
City	:	MAYWOOD
State	:	IL
Zip	:	60153-1835
Country	:	US
Telephone Number	:	708-540-3256
Fax Number	:

Provider Business Practice Location Address
First Line	:	1950 W POLK ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3723
Country	:	US
Telephone Number	:	312-864-6000
Fax Number	:

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

Provider Enumeration Date	:	06/11/2020
Last Update Date	:	02/02/2026

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