Basic Information
| Provider Information | |||||||||
| NPI: | 1932177458 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARRETT | ||||||||
| FirstName: | ANDREA | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 1195 GARNER FIELD RD BLDG B | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302783086 | ||||||||
| FaxNumber: | 8302788873 | ||||||||
| Practice Location | |||||||||
| Address1: | 1195 GARNER FIELD RD BLDG B | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | UVALDE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 788014820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8302783086 | ||||||||
| FaxNumber: | 8302788873 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2006 | ||||||||
| LastUpdateDate: | 01/10/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 60871 | WI | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207X00000X | MD35665 | WA | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
ID Information
| ID | Type | State | Issuer | Description | 0146359 | 01 | WA | LABOR AND INDUSTIRES | OTHER | 60871-20 | 01 | WI | WI STATE LIC | OTHER | 193192400 | 01 | US DEPARTMENT OF LABOR | OTHER | 8449035 | 05 | WA | MEDICAID | P00375433 | 01 | RAILROAD MEDICARE | OTHER | 80757600 | 05 | ID | MEDICAID | 4304BA | 01 | WA | LOCAL BLUE SHIELD PLAN | OTHER |