Provider Demographics
NPI:1528001765
Name:BARRETT, KASIE DEANN (FNP-BC)
Entity type:Individual
Prefix:
First Name:KASIE
Middle Name:DEANN
Last Name:BARRETT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 GREEN RD STE M&N
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:GA
Mailing Address - Zip Code:30705-6997
Mailing Address - Country:US
Mailing Address - Phone:706-260-8006
Mailing Address - Fax:
Practice Address - Street 1:1422 GREEN RD STE M&N
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:GA
Practice Address - Zip Code:30705-6997
Practice Address - Country:US
Practice Address - Phone:706-260-8006
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN20017363LF0000X
GARN149515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRP4720OtherGROUP #
GAGRP7341OtherGRP #
GRP4720OtherGROUP #