Provider Demographics
NPI:1316245954
Name:BARTLETT, KIM ELISE (CERTIFIED-PEER RECOV)
Entity type:Individual
Prefix:MRS
First Name:KIM
Middle Name:ELISE
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:CERTIFIED-PEER RECOV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 SW 38TH STREET
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-6912
Mailing Address - Country:US
Mailing Address - Phone:580-248-5780
Mailing Address - Fax:580-248-3610
Practice Address - Street 1:602 SW 38TH STREET
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-6912
Practice Address - Country:US
Practice Address - Phone:580-248-5780
Practice Address - Fax:580-248-3610
Is Sole Proprietor?:No
Enumeration Date:2011-03-07
Last Update Date:2011-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK08291174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist