Individual
HEATHER M BARRETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6308 8TH AVE, KENOSHA, WI 53143-5031
(262) 656-5330
Mailing address
PO BOX 130, KENOSHA, WI 53141-0130
(262) 656-2718
(262) 656-2749
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2017023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
391888660006
ANTHEM
WI
05
—
42892300
—
WI
Enumeration date
08/12/2006
Last updated
03/13/2008
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