Healthcare Provider Details

I. General information

NPI: 1073673893
Provider Name (Legal Business Name): KATHLEEN BONNIE BARRETT APRN BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: K BONNIE BARRETT APRN BC RN MS CA

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ALDRIN RD SOUTH BAY MENTAL HEALTH
PLYMOUTH MA
02360
US

IV. Provider business mailing address

30 WINDSOR POINT
MASHPEE MA
02649
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-0004
  • Fax: 508-830-0295
Mailing address:
  • Phone: 508-539-9178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number93966
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: