Provider Demographics
NPI:1962403378
Name:BARRETT, NANCY R (MD)
Entity type:Individual
Prefix:DR
First Name:NANCY
Middle Name:R
Last Name:BARRETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3024 BUSINESS PARK CIR
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-3132
Mailing Address - Country:US
Mailing Address - Phone:615-239-2018
Mailing Address - Fax:615-851-2018
Practice Address - Street 1:1409 W BADDOUR PKWY
Practice Address - Street 2:STE D
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2599
Practice Address - Country:US
Practice Address - Phone:615-784-6784
Practice Address - Fax:615-443-1080
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92210208600000X
TN37768208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1515071Medicaid
FLME92210OtherMEDICAL LICENSE#
FLK7582OtherMEDICARE GOUP #
H89191Medicare UPIN
FL01295ZMedicare ID - Type UnspecifiedPROVIDER #
FLH89191Medicare UPIN
TN38877031Medicare PIN