Provider Demographics
NPI:1306983382
Name:BARKER, NANCY ANN (PA-C)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:ANN
Last Name:BARKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:MELROSE
Mailing Address - State:MA
Mailing Address - Zip Code:02176-1129
Mailing Address - Country:US
Mailing Address - Phone:781-665-6504
Mailing Address - Fax:617-739-8632
Practice Address - Street 1:300 LONGWOOD AVE
Practice Address - Street 2:BADER 2
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5724
Practice Address - Country:US
Practice Address - Phone:617-355-6508
Practice Address - Fax:617-739-8632
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
MA2297363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical