Provider Demographics
NPI:1285688796
Name:BARRETT, KATHLEEN R (CRNA)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:R
Last Name:BARRETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:7 INDEPENDENCE PT STE 300
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4569
Practice Address - Country:US
Practice Address - Phone:864-522-3700
Practice Address - Fax:864-522-3705
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPRN1419367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0966Medicaid
SC430060706OtherMEDICARE RAILROAD
SCQ32546Medicare UPIN
SC20014863OtherINDIVIDUAL SELECT HEALTH
SC576007863OtherBLUE CHOICE
SC20031911OtherSELECT HEALTH GROUP
SC430060706OtherMEDICARE RAILROAD
SCQ32546Medicare UPIN
SC576007863OtherCIGNA
SC576007863OtherBCBS