1912284282 NPI number — ALYSSA JEAN BARKMAN P.A.-C.

Table of content: ALYSSA JEAN BARKMAN P.A.-C. (NPI 1912284282)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912284282 NPI number — ALYSSA JEAN BARKMAN P.A.-C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARKMAN
Provider First Name:
ALYSSA
Provider Middle Name:
JEAN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
P.A.-C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POSTERICK
Provider Other First Name:
ALYSSA
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912284282
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2550 UNIVERSITY AVE W
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
SAINT PAUL
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55114-2001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-602-5311
Provider Business Mailing Address Fax Number:
651-222-3786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6025 LAKE ROAD
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
WOODBURY
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55125-1709
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-735-7414
Provider Business Practice Location Address Fax Number:
651-735-1827
Provider Enumeration Date:
11/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 11044 . This is a "LICENSE PHYSICIAN ASSISTANT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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