Provider Demographics
NPI:1386351641
Name:BARRY, KATHRYN (LM)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:BARRY
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 PITT AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3747
Mailing Address - Country:US
Mailing Address - Phone:707-293-6612
Mailing Address - Fax:
Practice Address - Street 1:490 PITT AVE
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3747
Practice Address - Country:US
Practice Address - Phone:707-293-6612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-04
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA404176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife