Provider Demographics
NPI:1396911301
Name:BARRETT, MARY ANN (NP)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ANN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2248 GLEN EAGLE WAY
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-7380
Mailing Address - Country:US
Mailing Address - Phone:765-935-5600
Mailing Address - Fax:
Practice Address - Street 1:2248 GLEN EAGLE WAY
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-7380
Practice Address - Country:US
Practice Address - Phone:765-935-5600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-30
Last Update Date:2017-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001483A363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000681399OtherANTHEM
IN100321640Medicaid
INM400024911Medicare PIN