Provider Demographics
NPI:1265865265
Name:BARRETT, CAROLINE ANNE (CNP)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ANNE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:ANNE
Other - Last Name:WYMA-TSCHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1107 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5009
Mailing Address - Country:US
Mailing Address - Phone:575-622-5705
Mailing Address - Fax:575-622-5708
Practice Address - Street 1:1205 S SOLANO DR STE B
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-3709
Practice Address - Country:US
Practice Address - Phone:575-524-9119
Practice Address - Fax:575-525-1889
Is Sole Proprietor?:No
Enumeration Date:2013-08-13
Last Update Date:2019-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02330363LF0000X
WAAP60399117207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNPI & TIN#OtherBCBS OF NM
NM54430267Medicaid
NMNPI & TIN#OtherBCBS OF NM