Provider Demographics
NPI:1255850301
Name:BARKER, KATHERINE LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:LYNN
Last Name:BARKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:LYNN
Other - Last Name:BARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:712 MONTGOMERY HILL RD
Mailing Address - Street 2:
Mailing Address - City:WALKER
Mailing Address - State:WV
Mailing Address - Zip Code:26180-6002
Mailing Address - Country:US
Mailing Address - Phone:304-991-0424
Mailing Address - Fax:
Practice Address - Street 1:328 LINCOLNSHIRE DR
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:WV
Practice Address - Zip Code:26150-6002
Practice Address - Country:US
Practice Address - Phone:304-991-0424
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-10
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH351598163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV$$$$$$$$$Medicaid