Provider Demographics
NPI:1326304239
Name:BARRETT, NICHOLAS RICHARD (PA)
Entity type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:RICHARD
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:38935 ANN ARBOR RD
Mailing Address - Street 2:CREDENTIALING DEPT
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3397
Mailing Address - Country:US
Mailing Address - Phone:734-632-0175
Mailing Address - Fax:866-250-6385
Practice Address - Street 1:1551 E TANGERINE RD
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-6213
Practice Address - Country:US
Practice Address - Phone:520-901-3500
Practice Address - Fax:659-235-6176
Is Sole Proprietor?:No
Enumeration Date:2012-04-04
Last Update Date:2025-01-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5601006350363A00000X
TXPA11042363A00000X
AZ10934363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI12403275OtherCAQH