Provider Demographics
NPI:1659309193
Name:BARRETT, WILLIAM T (CRNA)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:T
Last Name:BARRETT
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 MOCKSVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:NC
Mailing Address - Zip Code:28144
Mailing Address - Country:US
Mailing Address - Phone:704-638-5661
Mailing Address - Fax:704-210-5384
Practice Address - Street 1:612 MOCKSVILLE AVE
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:NC
Practice Address - Zip Code:28144-2732
Practice Address - Country:US
Practice Address - Phone:704-638-5661
Practice Address - Fax:704-210-5384
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2011-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC138423367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8051513Medicaid
NC2602297Medicare PIN