Healthcare Provider Details

I. General information

NPI: 1689109761
Provider Name (Legal Business Name): JAMAL BARRETT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2017
Last Update Date: 04/11/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7607 DIXIE HWY
FLORENCE KY
41042-2644
US

IV. Provider business mailing address

215 E 11TH ST
NEWPORT KY
41071-2203
US

V. Phone/Fax

Practice location:
  • Phone: 859-655-6100
  • Fax:
Mailing address:
  • Phone: 859-655-6100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number57386
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberTP149
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: