Provider Demographics
NPI:1295997492
Name:BARNETT, JACQUELINE (MSHS, PA-C)
Entity type:Individual
Prefix:PROF
First Name:JACQUELINE
Middle Name:
Last Name:BARNETT
Suffix:
Gender:F
Credentials:MSHS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENBELT RD STE M16
Mailing Address - Street 2:
Mailing Address - City:BERWYN HEIGHTS
Mailing Address - State:MD
Mailing Address - Zip Code:20740-2333
Mailing Address - Country:US
Mailing Address - Phone:301-441-4400
Mailing Address - Fax:301-441-3008
Practice Address - Street 1:6201 GREENBELT RD STE M16
Practice Address - Street 2:
Practice Address - City:BERWYN HEIGHTS
Practice Address - State:MD
Practice Address - Zip Code:20740-2333
Practice Address - Country:US
Practice Address - Phone:301-441-4400
Practice Address - Fax:301-441-3008
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-28
Last Update Date:2008-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0001643363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical