Provider Demographics
NPI:1184688855
Name:BARTLEY, BILLIE (PAC)
Entity Type:Individual
Prefix:
First Name:BILLIE
Middle Name:
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:BILLIE
Other - Middle Name:
Other - Last Name:RATLIFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 ADAMS LN
Mailing Address - Street 2:SUITE 600-700
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-3087
Mailing Address - Country:US
Mailing Address - Phone:606-509-2000
Mailing Address - Fax:606-509-2002
Practice Address - Street 1:140 ADAMS LN
Practice Address - Street 2:SUITE 600-700
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-3087
Practice Address - Country:US
Practice Address - Phone:606-509-2000
Practice Address - Fax:606-509-2002
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100146710OtherMEDICAID PRIMARY CARE EKAHC
KY000000527383OtherBCBS
KY950010200Medicaid
KY7100146710OtherMEDICAID PRIMARY CARE EKAHC
KY950010200Medicaid
KY5490Medicare PIN
KY000000527383OtherBCBS
KY3331039Medicare ID - Type Unspecified
KY8577Medicare PIN