Basic Information
Provider Information
NPI: 1487804076
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BARRETT
FirstName: ERIN
MiddleName: R
NamePrefix:  
NameSuffix:  
Credential: PAC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 780
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 265070780
CountryCode: US
TelephoneNumber: 3042937401
FaxNumber:  
Practice Location
Address1: 1 MEDICAL CENTER DRIVE
Address2:  
City: MORGANTOWN
State: WV
PostalCode: 26506
CountryCode: US
TelephoneNumber: 3045984800
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/19/2008
LastUpdateDate: 10/17/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X01370WVY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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