Individual
DR. ANDREA KELLY BARKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1340 BROAD AVE STE 220, GULFPORT, MS 39501-2465
(228) 575-1300
(228) 867-6423
Mailing address
PO BOX 1810, GULFPORT, MS 39502-1810
(228) 575-1194
(228) 575-2917
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
T-1879
MS
2086S0129X
Vascular Surgery Physician
Primary
21286
MS
2086S0129X
Vascular Surgery Physician
28021
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922201430
—
MS
Enumeration date
06/25/2007
Last updated
09/22/2021
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