Healthcare Provider Details

I. General information

NPI: 1598921595
Provider Name (Legal Business Name): KAREN B. BARRETT MS, PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W. OVERLAND ROAD FIRSTLINE MEDICAL
BOISE ID
83704
US

IV. Provider business mailing address

2619 N SILVERLEAF WAY
MERIDIAN ID
83646-3963
US

V. Phone/Fax

Practice location:
  • Phone: 208-323-7588
  • Fax: 206-202-8007
Mailing address:
  • Phone: 208-898-1361
  • Fax: 206-202-8007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-328
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: