Provider Demographics
NPI:1437151982
Name:HARTLEY, MARY KAY (ACNP)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:MARY KAY
Other - Middle Name:
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ACNP
Mailing Address - Street 1:4375 BOOTH CALLOWAY
Mailing Address - Street 2:STE 307
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-8362
Mailing Address - Country:US
Mailing Address - Phone:817-284-4343
Mailing Address - Fax:817-590-4393
Practice Address - Street 1:4375 BOOTH CALLOWAY
Practice Address - Street 2:STE 307
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-8362
Practice Address - Country:US
Practice Address - Phone:817-284-4343
Practice Address - Fax:817-590-4393
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX515399363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX192926701Medicaid
TXTXB101513Medicare PIN