=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124352018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KATHRYN A BARRETT MD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/24/2009
-----------------------------------------------------
Last Update Date | 09/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 740 SHERIDAN LAKE RD SUITE B
-----------------------------------------------------
City | RAPID CITY
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57702-0900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-718-5566
-----------------------------------------------------
Fax | 605-718-5568
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 740 SHERIDAN LAKE RD SUITE B
-----------------------------------------------------
City | RAPID CITY
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57702-0900
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-718-5566
-----------------------------------------------------
Fax | 605-718-5568
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | ANN M PRYOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 605-718-5566
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 3638
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------