Provider Demographics
NPI:1609847441
Name:BARRETT, PAUL WESLEY (CFNP)
Entity Type:Individual
Prefix:MR
First Name:PAUL
Middle Name:WESLEY
Last Name:BARRETT
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:321 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-1920
Mailing Address - Country:US
Mailing Address - Phone:662-327-2921
Mailing Address - Fax:662-328-6858
Practice Address - Street 1:321 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39705-1920
Practice Address - Country:US
Practice Address - Phone:662-327-2921
Practice Address - Fax:662-328-6858
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR827931363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00120110Medicaid
MS25D0320153OtherCLIA
AL009930250Medicaid
P00747430OtherRAILROAD MEDICARE
AL731-05484OtherBLUE CROSS
MS302I507202Medicare PIN
AL009930250Medicaid