Provider Demographics
NPI:1457409542
Name:BARTLETT, JACQUELINE F (PAC)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:F
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:SISSETON
Mailing Address - State:SD
Mailing Address - Zip Code:57262-2312
Mailing Address - Country:US
Mailing Address - Phone:605-698-7681
Mailing Address - Fax:605-698-6401
Practice Address - Street 1:205 ORCHARD DR
Practice Address - Street 2:
Practice Address - City:SISSETON
Practice Address - State:SD
Practice Address - Zip Code:57262-2312
Practice Address - Country:US
Practice Address - Phone:605-698-7681
Practice Address - Fax:605-698-6401
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0376363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6821502Medicaid
SDS102742Medicare PIN
SD6821502Medicaid
SDS102232Medicare Oscar/Certification
SDS7316Medicare PIN