Provider Demographics
NPI:1194876771
Name:BARNETT, MARY M (CNM, APRN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:M
Last Name:BARNETT
Suffix:
Gender:F
Credentials:CNM, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1704 TREADWELL ST.
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704
Mailing Address - Country:US
Mailing Address - Phone:512-771-2205
Mailing Address - Fax:866-497-7994
Practice Address - Street 1:1704 TREADWELL ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-2146
Practice Address - Country:US
Practice Address - Phone:512-444-4893
Practice Address - Fax:866-497-7994
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX232732364SW0102X, 367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXR58661Medicare UPIN