Provider Demographics
NPI:1750045688
Name:BARTLEY, CONNIE ANNETTE (LPN)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ANNETTE
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HARTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37074-1220
Mailing Address - Country:US
Mailing Address - Phone:615-374-2112
Mailing Address - Fax:615-374-1119
Practice Address - Street 1:541 E MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37074-1220
Practice Address - Country:US
Practice Address - Phone:615-374-2112
Practice Address - Fax:615-374-1119
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61470164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse