Provider Demographics
NPI:1437872850
Name:BARTLEY, SANDRA KAY
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:KAY
Last Name:BARTLEY
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 1:1 AVENUE C BLDG SUITE109
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1100
Mailing Address - Country:US
Mailing Address - Phone:304-369-6400
Mailing Address - Fax:304-369-0046
Practice Address - Street 1:1 AVENUE C BLDG SUITE109
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1100
Practice Address - Country:US
Practice Address - Phone:304-369-6400
Practice Address - Fax:304-369-0046
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant