Provider Demographics
NPI:1386189850
Name:BARTLETT, KIMBERLI
Entity Type:Individual
Prefix:
First Name:KIMBERLI
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3246 RAMOS CIR
Mailing Address - Street 2:STE.B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2548
Mailing Address - Country:US
Mailing Address - Phone:916-719-4005
Mailing Address - Fax:916-346-4340
Practice Address - Street 1:3246 RAMOS CIR
Practice Address - Street 2:STE.B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827-2548
Practice Address - Country:US
Practice Address - Phone:916-719-4005
Practice Address - Fax:916-346-4340
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN166920164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse