Provider Demographics
NPI:1386604684
Name:BARRETT, KATHLEEN M (NP)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BARRETT
Suffix:
Gender:F
Credentials:NP
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Mailing Address - Street 1:8170 33RD AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-4516
Mailing Address - Country:US
Mailing Address - Phone:651-254-8680
Mailing Address - Fax:651-254-8656
Practice Address - Street 1:435 PHALEN BLVD
Practice Address - Street 2:51103B
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55130-5302
Practice Address - Country:US
Practice Address - Phone:651-254-8600
Practice Address - Fax:651-254-8638
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2019-02-08
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Provider Licenses
StateLicense IDTaxonomies
MNR0932864363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN305481100Medicaid
Q27838Medicare UPIN
MN500002953Medicare ID - Type Unspecified