=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679885529
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JESSICA BARRETO M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/08/2010
-----------------------------------------------------
Last Update Date | 04/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 N MAIN ST
-----------------------------------------------------
City | FORT WORTH
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76164-9416
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-518-7785
-----------------------------------------------------
Fax | 214-645-0078
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5323 HARRY HINES BLVD
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75390-3718
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 469-626-8512
-----------------------------------------------------
Fax | 214-645-0078
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 125.058679
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------