Provider Demographics
NPI:1326712324
Name:BARTLEY, JERRY RAY
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:RAY
Last Name:BARTLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 CAMINO BAJO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8614
Mailing Address - Country:US
Mailing Address - Phone:505-474-7684
Mailing Address - Fax:
Practice Address - Street 1:49 CAMINO BAJO
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87508-8614
Practice Address - Country:US
Practice Address - Phone:505-474-7684
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-03
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator