Basic Information
Provider Information | |||||||||
NPI: | 1932628666 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BARBER | ||||||||
FirstName: | KATRECE | ||||||||
MiddleName: | J | ||||||||
NamePrefix: | MRS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | NP | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WRIGHT | ||||||||
OtherFirstName: | KATRECE | ||||||||
OtherMiddleName: | J | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 9544 W TAMPA DR | ||||||||
Address2: |   | ||||||||
City: | BATON ROUGE | ||||||||
State: | LA | ||||||||
PostalCode: | 708158952 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2252234122 | ||||||||
FaxNumber: | 2252617546 | ||||||||
Practice Location | |||||||||
Address1: | 6685 SULLIVAN RD | ||||||||
Address2: |   | ||||||||
City: | GREENWELL SPRINGS | ||||||||
State: | LA | ||||||||
PostalCode: | 707393112 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8002563947 | ||||||||
FaxNumber: | 8006091694 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/13/2017 | ||||||||
LastUpdateDate: | 07/21/2022 | ||||||||
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 | 363LF0000X | AP09562 | LA | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
ID | Type | State | Issuer | Description | NONE | 01 | LA | ALL ARE APPLIED FOR | OTHER |