Healthcare Provider Details

I. General information

NPI: 1215935358
Provider Name (Legal Business Name): BARBARA JEAN BARRETT DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BARBARA JEAN BRAINERD DPM

II. Dates (important events)

Enumeration Date: 07/12/2005
Last Update Date: 12/23/2021
Certification Date: 12/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N BRYANT AVE
EDMOND OK
73034-3206
US

IV. Provider business mailing address

9600 BROADWAY EXT
OKLAHOMA CITY OK
73114-7408
US

V. Phone/Fax

Practice location:
  • Phone: 405-230-9200
  • Fax: 405-230-9245
Mailing address:
  • Phone: 405-230-9200
  • Fax: 405-330-5591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number176
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number000582
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number176
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: