Provider Demographics
NPI:1568769032
Name:BARRETT, KELLIE M (PA)
Entity Type:Individual
Prefix:MS
First Name:KELLIE
Middle Name:M
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:
Other - Last Name:FERRO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1301 BARBARA JORDAN BLVD STE 200G
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3078
Mailing Address - Country:US
Mailing Address - Phone:512-380-9200
Mailing Address - Fax:512-380-9201
Practice Address - Street 1:1301 BARBARA JORDAN BLVD STE 200G
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723-3078
Practice Address - Country:US
Practice Address - Phone:512-380-9200
Practice Address - Fax:512-380-9201
Is Sole Proprietor?:No
Enumeration Date:2011-02-18
Last Update Date:2023-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07119363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX323789303Medicaid
TX323789304Medicaid
TX323789303Medicaid