Provider Demographics
NPI:1386041101
Name:BARRETT, DUSTIN L (PA)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:L
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:105 W STONE DR
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3365
Mailing Address - Country:US
Mailing Address - Phone:423-408-7220
Mailing Address - Fax:423-408-7405
Practice Address - Street 1:2050 MEADOWWVIEW PKWY.
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-7475
Practice Address - Country:US
Practice Address - Phone:423-230-5000
Practice Address - Fax:423-230-5035
Is Sole Proprietor?:No
Enumeration Date:2014-11-21
Last Update Date:2015-03-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN2687363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I978556Medicare PIN