Healthcare Provider Details

I. General information

NPI: 1265501746
Provider Name (Legal Business Name): KATHLEEN M BARRETT CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN M GAGNIER CRNP

II. Dates (important events)

Enumeration Date: 11/07/2006
Last Update Date: 06/15/2020
Certification Date: 06/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 RIDGELY AVENUE SUITE 222
ANNAPOLIS MD
21401
US

IV. Provider business mailing address

600 RIDGELY AVENUE SUITE 130
ANNAPOLIS MD
21401
US

V. Phone/Fax

Practice location:
  • Phone: 410-266-8049
  • Fax: 410-266-0895
Mailing address:
  • Phone: 410-266-8049
  • Fax: 410-266-0895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR159830
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: