Provider Demographics
NPI:1568584886
Name:BACHTEL, MARY KATHLEEN JONES (FNP-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:KATHLEEN JONES
Last Name:BACHTEL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4124 HUNT ST SW
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:GA
Mailing Address - Zip Code:30014-2750
Mailing Address - Country:US
Mailing Address - Phone:770-786-3412
Mailing Address - Fax:770-784-8473
Practice Address - Street 1:100 HAMILL ST
Practice Address - Street 2:OXFORD COLLEGE SHS
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-2291
Practice Address - Country:US
Practice Address - Phone:770-784-8376
Practice Address - Fax:770-784-8473
Is Sole Proprietor?:No
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123161363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily