Provider Demographics
NPI:1932652104
Name:BARRETT, BRENNAN N (NP-C)
Entity Type:Individual
Prefix:
First Name:BRENNAN
Middle Name:N
Last Name:BARRETT
Suffix:
Gender:F
Credentials:NP-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 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-962-1337
Mailing Address - Fax:765-966-0858
Practice Address - Street 1:1100 REID PKWY STE 210
Practice Address - Street 2:RICHMOND CARDIOLOGY ASSOCIATES
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1157
Practice Address - Country:US
Practice Address - Phone:765-962-1337
Practice Address - Fax:765-966-0858
Is Sole Proprietor?:No
Enumeration Date:2016-07-25
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006352A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201375610Medicaid
OH0177574Medicaid
000001030990OtherANTHEM
IN259370170Medicare PIN