Healthcare Provider Details

I. General information

NPI: 1679351902
Provider Name (Legal Business Name): KATARINA MIJIC-BARISIC PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 12/18/2023
Certification Date: 12/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 SUNSET LN STE 4230
CULPEPER VA
22701-3300
US

IV. Provider business mailing address

1500 WESTBRANCH DR APT 713
MC LEAN VA
22102-3292
US

V. Phone/Fax

Practice location:
  • Phone: 216-924-8879
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024189029
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: