1275129686 NPI number — SHARON LYNN BARTLEY MSN FNP-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275129686 NPI number — SHARON LYNN BARTLEY MSN FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTLEY
Provider First Name:
SHARON
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275129686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 155
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHRISTOPHER
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62822-0155
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-724-2401
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
206 E CHURCH ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENTON
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62812-2239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-435-9888
Provider Business Practice Location Address Fax Number:
618-435-9889
Provider Enumeration Date:
12/19/2020

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  RN60556738 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 209023608 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: F04210273 . This is a "FNP" identifier . This identifiers is of the category "OTHER".
  • Identifier: RN60556738 . This is a "NURSING BOARD" identifier , issued by the state of ( WA ) . This identifiers is of the category "OTHER".




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