Provider Demographics
NPI:1639942196
Name:BARTLETT, BAILEY JONNA-RAE
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:JONNA-RAE
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 1:5414 TENNESSEE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37409-2129
Mailing Address - Country:US
Mailing Address - Phone:423-994-6074
Mailing Address - Fax:
Practice Address - Street 1:5414 TENNESSEE AVE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37409-2129
Practice Address - Country:US
Practice Address - Phone:423-994-6074
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4675133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered