Provider Demographics
NPI:1144545781
Name:BARKLEY, KYLER W (MD)
Entity type:Individual
Prefix:
First Name:KYLER
Middle Name:W
Last Name:BARKLEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 NASHVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79410-1105
Mailing Address - Country:US
Mailing Address - Phone:806-725-5844
Mailing Address - Fax:806-723-6532
Practice Address - Street 1:3514 21ST ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1210
Practice Address - Country:US
Practice Address - Phone:806-725-1801
Practice Address - Fax:806-723-7535
Is Sole Proprietor?:No
Enumeration Date:2010-04-06
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TXP3506207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX583990YKT8OtherMEDICARE
NM68080361Medicaid
TXP01978298OtherRAILROAD MEDICARE
TX8GX814OtherBCBS
TX373897301Medicaid