Provider Demographics
NPI:1437374600
Name:BARRETT, MARY ALISON (FNP)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ALISON
Last Name:BARRETT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440A W EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:PALMER
Mailing Address - State:AK
Mailing Address - Zip Code:99645-6955
Mailing Address - Country:US
Mailing Address - Phone:907-746-3366
Mailing Address - Fax:907-746-3368
Practice Address - Street 1:440A W EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:PALMER
Practice Address - State:AK
Practice Address - Zip Code:99645-6955
Practice Address - Country:US
Practice Address - Phone:907-746-3366
Practice Address - Fax:907-746-3368
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK283363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKNP89312Medicaid