Provider Demographics
NPI:1184811960
Name:BARNETTE, FRED T III
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:T
Last Name:BARNETTE
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:984 JACKSON STREET
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71202
Mailing Address - Country:US
Mailing Address - Phone:318-330-7300
Mailing Address - Fax:318-330-7300
Practice Address - Street 1:984 JACKSON STREET
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202
Practice Address - Country:US
Practice Address - Phone:318-330-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN074682/AP05295363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1024309Medicaid
LA3A430F600Medicare PIN