Provider Demographics
NPI:1144349648
Name:BARRETT, AMANDA MARIRE (PA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:MARIRE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:MARIE
Other - Last Name:MILNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6112 E BROWN RD
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205-4955
Mailing Address - Country:US
Mailing Address - Phone:480-924-4422
Mailing Address - Fax:480-924-8822
Practice Address - Street 1:6112 E BROWN RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205-4955
Practice Address - Country:US
Practice Address - Phone:480-924-4422
Practice Address - Fax:480-924-8822
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3360363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ138609Medicare PIN