=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932628666
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KATRECE J BARBER NP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/13/2017
-----------------------------------------------------
Last Update Date | 10/16/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10310 THE GROVE BLVD
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70836-6455
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-761-5200
-----------------------------------------------------
Fax | 225-761-5425
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9544 W TAMPA DR
-----------------------------------------------------
City | BATON ROUGE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70815-8952
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 225-223-7780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP09562
-----------------------------------------------------
License Number State | LA
-----------------------------------------------------