Provider Demographics
NPI:1598816506
Name:BARTLETT, AMPARO (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MRS
First Name:AMPARO
Middle Name:
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 SUNFISH AVE.
Mailing Address - Street 2:
Mailing Address - City:RUSSELLVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72802-2300
Mailing Address - Country:US
Mailing Address - Phone:479-967-2427
Mailing Address - Fax:
Practice Address - Street 1:203 WEIR RD
Practice Address - Street 2:
Practice Address - City:RUSSELLVILLE
Practice Address - State:AR
Practice Address - Zip Code:72802-9405
Practice Address - Country:US
Practice Address - Phone:479-968-6004
Practice Address - Fax:479-964-0928
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01072363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR440117801Medicaid