Provider Demographics
NPI:1760512719
Name:BARTZ, KATHY ANN
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:BARTZ
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 1:307 S GREENSTONE LN
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75116-4418
Mailing Address - Country:US
Mailing Address - Phone:972-296-9109
Mailing Address - Fax:972-296-9109
Practice Address - Street 1:307 S GREENSTONE LN
Practice Address - Street 2:
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116-4418
Practice Address - Country:US
Practice Address - Phone:972-296-9109
Practice Address - Fax:972-296-9109
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX118860310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility