Provider Demographics
NPI:1952553869
Name:BARRETT, MITCHELL (APRN)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:BARRETT
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8074 S 84TH ST
Mailing Address - Street 2:
Mailing Address - City:LA VISTA
Mailing Address - State:NE
Mailing Address - Zip Code:68128-3303
Mailing Address - Country:US
Mailing Address - Phone:402-991-9500
Mailing Address - Fax:402-991-9564
Practice Address - Street 1:8074 S 84TH ST
Practice Address - Street 2:
Practice Address - City:LA VISTA
Practice Address - State:NE
Practice Address - Zip Code:68128-3303
Practice Address - Country:US
Practice Address - Phone:402-991-9500
Practice Address - Fax:402-991-9564
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE110993363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE110993OtherLICENSE
NE10026518600Medicaid
NE110993OtherLICENSE
NE096573032Medicare PIN