Kimberley Lis Barracco, DO
Individual provider Active NPI Pediatrics Physician · Saint Albans, WV
NPI 1700984366 · NPPES record last updated Sep 18, 2023
Key facts
- NPI
- 1700984366
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 2064 (WV)
- Practice address
- 12 Kanawha Ter
Saint Albans, WV 25177-2750 - Phone
- (304) 757-6999
- NPI assigned
- Sep 20, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20061120000105 | WV | Practitioner - Pediatric Medicine | 7012915416 | Reassigns benefits to 6 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39076 | SC | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Womencare Inc | Current | Accepting new patients | |
| Womencare, Inc | Current |
Accepting new patients | |
| Womencare Inc | Current |
Accepting new patients | |
| Womencare, Inc | Current | Accepting new patients | |
| Womencare Inc | Current |
Accepting new patients | |
| Womencare Inc | Current | Accepting new patients | |
| Womencare Inc | Current | Accepting new patients | |
| Womencare Inc | Current | Accepting new patients | |
| Womencare Inc | Current | Accepting new patients | |
| Womencare Inc | Current | Accepting new patients | |
| Womencare Inc | Current |
Accepting new patients | |
| Womencare Inc | Current |
Accepting new patients | |
| Womencare, Inc | Current | Accepting new patients | |
| Womencare, Inc | Current | Accepting new patients | |
| Womencare Inc | Past | Accepting new patients | |
| Womencare Inc | Pediatrics | Past | Accepting new patients |
| Womencare Inc | Past | Accepting new patients |
Locations
2 Chateau Ln
Barboursville, WV 25504
Phone (304) 736-9459
800 Pennsylvania Ave
Charleston, WV 25302
Phone (304) 388-2550
812 Park Ave
#35
Charleston, WV 25302
Phone (304) 720-4466
116 Hills Plz
Charleston, WV 25387
Phone (304) 720-4446
1220 Lee St E
Ste 201
Charleston, WV 25301
Phone (304) 342-7186
108 Washington St W
Ste 201
Charleston, WV 25302
Phone (304) 345-2229
1500 Greenbrier St
Ste 160
Charleston, WV 25311
812 Park Ave
Rm 35
Charleston, WV 25302
100 Florida St
Charleston, WV 25302
Phone (304) 348-6613
5161 Washington St W
Cross Lanes, WV 25313
Phone (304) 722-7600
301 Washington Ave
Rm 4
Dunbar, WV 25064
503 Roosevelt Blvd
Eleanor, WV 25070
Phone (304) 586-0001
3911 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 757-4845
3109 Teays Valley Rd
Hurricane, WV 25526
Phone (304) 562-2002
515 Main St
Madison, WV 25130
Phone (304) 369-0393
9709 Maccorkle Ave
#B
Marmet, WV 25315
12 Kanawha Ter
Saint Albans, WV 25177
Phone (304) 201-1130
97 Great Teays Blvd
Ste 6
Scott Depot, WV 25560
Interoperability endpoints
- https://api.platform.athenahealth.com/7363/brand/1/csg/1/fhir/r4
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 39076 | SC | |
| Pediatrics Physician | 208000000X | 2064 | WV | Yes |
Addresses
Primary practice location
12 Kanawha Ter
Saint Albans, WV 25177-2750
Mailing address
PO Box 2168
Spartanburg, SC 29304-2168
Phone (864) 560-4304
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001879423 | Other | BLUE CROSS BLUE SHEILD | |
| 7070869 | Other | AETNA | |
| 390767 | Medicaid | SC | |
| SCC510H895 | Other | SC | MEDICARE PIN |
| 3810005951 | Medicaid | WV |
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kbarracco77946@direct-srhs.et0939.epichosted.com | Direct |
Other providers in Saint Albans, WV
- Brittany Kay Baldwin
- Vickie Baldwin
- Amy Barkley
- Amanda Barlow
- Amy Barnhart
- Jeffrey Barth
- Christal Barton
- Jesylyn Baumbush
- Judy Baxter
- Kristen Bays
All providers in Saint Albans, WV · Pediatrics Physician in West Virginia
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 18, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.