Provider Demographics
NPI:1649415852
Name:BARRETT, MARCIA KAY (LPN)
Entity Type:Individual
Prefix:MRS
First Name:MARCIA
Middle Name:KAY
Last Name:BARRETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:IN
Mailing Address - Zip Code:46030-0571
Mailing Address - Country:US
Mailing Address - Phone:131-798-4480
Mailing Address - Fax:
Practice Address - Street 1:300 N CHURCH ST.
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:IN
Practice Address - Zip Code:46030-0571
Practice Address - Country:US
Practice Address - Phone:131-798-4480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN27009039A164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN27009039AOtherLPN