Provider Demographics
NPI:1326549601
Name:BARRETT, MEMORY
Entity Type:Individual
Prefix:
First Name:MEMORY
Middle Name:
Last Name:BARRETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3009 FLUTTERMILL DR
Mailing Address - Street 2:
Mailing Address - City:HEARTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75126-0835
Mailing Address - Country:US
Mailing Address - Phone:469-587-4886
Mailing Address - Fax:
Practice Address - Street 1:3009 FLUTTERMILL DR
Practice Address - Street 2:
Practice Address - City:HEARTLAND
Practice Address - State:TX
Practice Address - Zip Code:75126-7512
Practice Address - Country:US
Practice Address - Phone:469-587-4886
Practice Address - Fax:469-587-4886
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX316528164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse