Basic Information
| Provider Information | |||||||||
| NPI: | 1114257342 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARRETT | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | ANN | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18444 N 25TH AVE | ||||||||
| Address2: | SUITE 310 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850231261 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235375600 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Practice Location | |||||||||
| Address1: | 1450 S DOBSON RD | ||||||||
| Address2: | SUITE B122 | ||||||||
| City: | MESA | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852024712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6235375600 | ||||||||
| FaxNumber: | 8669392673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/11/2010 | ||||||||
| LastUpdateDate: | 01/20/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AS0400X | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical | 363AS0400X | 4589 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 5550830006 | 01 | AZ | MEDICARE NSC ANTHEM | OTHER | 5550830007 | 01 | AZ | MEDICARE NSC DV | OTHER | 5550830010 | 01 | AZ | MEDICARE NSC GIBLERT | OTHER | 5550830004 | 01 | AZ | MEDICARE NSC PV | OTHER | 5550830008 | 01 | AZ | MEDICARE NSC SWV | OTHER | 5550830001 | 01 | AZ | MEDICARE NSC SCW | OTHER | 5550830009 | 01 | AZ | MEDICARE NSC AZ NORTH | OTHER | 5550830003 | 01 | AZ | MEDICARE NSC PEORIA | OTHER |