Provider Demographics
NPI:1285890806
Name:BARKLEY, DARLY G (DENTAL HYGIENIST)
Entity type:Individual
Prefix:MRS
First Name:DARLY
Middle Name:G
Last Name:BARKLEY
Suffix:
Gender:F
Credentials:DENTAL HYGIENIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 KATHRYN AVE SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-4709
Mailing Address - Country:US
Mailing Address - Phone:505-363-3435
Mailing Address - Fax:505-265-5748
Practice Address - Street 1:5800 KATHRYN AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87108-4709
Practice Address - Country:US
Practice Address - Phone:505-363-3435
Practice Address - Fax:505-265-5748
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1351124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM84770287Medicaid