Provider Demographics
NPI:1073673893
Name:BARRETT, KATHLEEN BONNIE (APRN BC)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:BONNIE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:APRN BC
Other - Prefix:
Other - First Name:K
Other - Middle Name:BONNIE
Other - Last Name:BARRETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN BC RN MS CA
Mailing Address - Street 1:30 WINDSOR POINT
Mailing Address - Street 2:
Mailing Address - City:MASHPEE
Mailing Address - State:MA
Mailing Address - Zip Code:02649
Mailing Address - Country:US
Mailing Address - Phone:508-539-9178
Mailing Address - Fax:
Practice Address - Street 1:50 ALDRIN RD
Practice Address - Street 2:SOUTH BAY MENTAL HEALTH
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360
Practice Address - Country:US
Practice Address - Phone:508-830-0004
Practice Address - Fax:508-830-0295
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA93966163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse