MEDICARE: LAURA KATHERINE BARKER

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	103K00000X	Behavior Analyst		MS

General Provider Information

NPI Number	:	1700361763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA KATHERINE BARKER

Provider Business Mailing Address
First Line	:	1465 LAKELAND DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4719
Country	:	US
Telephone Number	:	769-777-1000
Fax Number	:	769-230-2863

Provider Business Practice Location Address
First Line	:	1513 LAKELAND DR
Second Line	:
City	:	JACKSON
State	:	MS
Zip	:	39216-4829
Country	:	US
Telephone Number	:	769-777-1104
Fax Number	:	769-777-1136

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

Provider Enumeration Date	:	09/26/2018
Last Update Date	:	09/26/2018

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Directions to “ LAURA KATHERINE BARKER ” Practice Location

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