Provider Demographics
NPI:1275500779
Name:BARRETT, KATHERINE ELLIS (MD)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ELLIS
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 1:4414 LAKE BOONE TRAIL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27607
Mailing Address - Country:US
Mailing Address - Phone:919-781-7450
Mailing Address - Fax:919-781-6355
Practice Address - Street 1:4414 LAKE BOONE TRAIL
Practice Address - Street 2:# 308 CAPITAL AREA OB GYN
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27607
Practice Address - Country:US
Practice Address - Phone:919-781-7450
Practice Address - Fax:919-781-6355
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC00180207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89126T2Medicaid
NC7807650OtherAETNA
NC155685OtherWELLPATH
NC562142486OtherBEECHSTREET
NC98211OtherMEDCOST
NC126T2OtherBCBS
NC562142486OtherUHC
NC7037390002OtherCIGNA
NC98211OtherMEDCOST
NC7037390002OtherCIGNA