1275500779 NPI number — KATHERINE ELLIS BARRETT MD

Table of content: KATHERINE ELLIS BARRETT MD (NPI 1275500779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275500779 NPI number — KATHERINE ELLIS BARRETT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARRETT
Provider First Name:
KATHERINE
Provider Middle Name:
ELLIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275500779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4414 LAKE BOONE TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RALEIGH
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-781-7450
Provider Business Mailing Address Fax Number:
919-781-6355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4414 LAKE BOONE TRAIL
Provider Second Line Business Practice Location Address:
# 308 CAPITAL AREA OB GYN
Provider Business Practice Location Address City Name:
RALEIGH
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-781-7450
Provider Business Practice Location Address Fax Number:
919-781-6355
Provider Enumeration Date:
03/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  00180 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 89126T2 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7807650 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 155685 . This is a "WELLPATH" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 562142486 . This is a "BEECHSTREET" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 98211 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 126T2 . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 562142486 . This is a "UHC" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 7037390002 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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