Provider Demographics
NPI:1922607373
Name:BARRETT, BENJAMIN ALLEN (PA-C)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ALLEN
Last Name:BARRETT
Suffix:
Gender:M
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 1:1100 MEREDITH LN APT 536
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-4668
Mailing Address - Country:US
Mailing Address - Phone:541-690-9796
Mailing Address - Fax:
Practice Address - Street 1:4700 POINT FOSDICK DR STE 220
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-1706
Practice Address - Country:US
Practice Address - Phone:253-851-5121
Practice Address - Fax:253-851-3059
Is Sole Proprietor?:No
Enumeration Date:2020-10-17
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA612228001363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant