Provider Demographics
NPI:1992955041
Name:BARBER WALKER, KELLY S (NP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:BARBER WALKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:960 HIGHWAY 352
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-6892
Mailing Address - Country:US
Mailing Address - Phone:214-391-2875
Mailing Address - Fax:214-391-3396
Practice Address - Street 1:960 HIGHWAY 352
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-6892
Practice Address - Country:US
Practice Address - Phone:214-391-2875
Practice Address - Fax:214-391-3396
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117052363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX198337101Medicaid
TX198337102Medicaid
TX198337103Medicaid
TX8L4576Medicare PIN
TX8L4650Medicare PIN
TX198337102Medicaid