Provider Demographics
NPI:1801204383
Name:BARRETT, TONNICHAKA L (CRNA)
Entity type:Individual
Prefix:
First Name:TONNICHAKA
Middle Name:L
Last Name:BARRETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TONNICHAKA
Other - Middle Name:L
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:185 WALNUT GARDENS DR
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-2907
Mailing Address - Country:US
Mailing Address - Phone:504-319-6330
Mailing Address - Fax:
Practice Address - Street 1:2430 EMERALD PL STE 201
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-5743
Practice Address - Country:US
Practice Address - Phone:252-752-2140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-28
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS901384367500000X
TX1140242367500000X
TN18962367500000X
GA198674367500000X
NC7717367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered