Provider Demographics
NPI:1720038292
Name:BARTA, KATHLEEN M (PA-C)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:M
Last Name:BARTA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S SUNNY SLOPE RD STE 136
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-4858
Mailing Address - Country:US
Mailing Address - Phone:262-786-4550
Mailing Address - Fax:262-786-4552
Practice Address - Street 1:150 S SUNNY SLOPE RD STE 136
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4858
Practice Address - Country:US
Practice Address - Phone:262-786-4550
Practice Address - Fax:262-786-4552
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1292-023363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42997400Medicaid
P13019Medicare UPIN