Provider Demographics
NPI:1043565724
Name:BARTLETT, BETHANY LYN (PMHNP)
Entity Type:Individual
Prefix:
First Name:BETHANY
Middle Name:LYN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3630
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86003
Mailing Address - Country:US
Mailing Address - Phone:928-213-6100
Mailing Address - Fax:
Practice Address - Street 1:42 SUMMER ST
Practice Address - Street 2:FL 2
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4624
Practice Address - Country:US
Practice Address - Phone:413-236-9100
Practice Address - Fax:615-237-1434
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTAP4530363LP0808X
MARN2284234363LP0808X
AZAP4530363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health