Individual
KIMBERLEY LIS BARRACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
2064
WV
208000000X
Pediatrics Physician
39076
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001879423
BLUE CROSS BLUE SHEILD
—
05
—
3810005951
—
WV
05
—
390767
—
SC
01
—
7070869
AETNA
—
01
—
SCC510H895
MEDICARE PIN
SC
Enumeration date
09/20/2006
Last updated
09/18/2023
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
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