Healthcare Provider Details

I. General information

NPI: 1952136848
Provider Name (Legal Business Name): MICHELLE MARIE BARRETT PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 09/11/2025
Certification Date: 09/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2341 LEWISVILLE CLEMMONS RD FL 2
CLEMMONS NC
27012-8905
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4039
  • Fax: 336-713-3288
Mailing address:
  • Phone: 336-716-2255
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5021991
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number236584
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: