Provider Demographics
NPI:1114355567
Name:BARRETTE, TARYN (PA-C)
Entity Type:Individual
Prefix:
First Name:TARYN
Middle Name:
Last Name:BARRETTE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:LEADVILLE
Mailing Address - State:CO
Mailing Address - Zip Code:80461
Mailing Address - Country:US
Mailing Address - Phone:719-486-0230
Mailing Address - Fax:719-486-7167
Practice Address - Street 1:825 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LEADVILLE
Practice Address - State:CO
Practice Address - Zip Code:80461-2205
Practice Address - Country:US
Practice Address - Phone:719-486-1264
Practice Address - Fax:719-486-1286
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8790991-1206363A00000X
COPA.0005127363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant