Provider Demographics
NPI:1760601967
Name:BARTELS, KIMBERLY LYNNE (WHCNP)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LYNNE
Last Name:BARTELS
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:LYNNE
Other - Last Name:SCHLAGEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:WHCNP
Mailing Address - Street 1:1200 N STATE ST STE 430
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39202-2027
Mailing Address - Country:US
Mailing Address - Phone:601-874-7141
Mailing Address - Fax:601-487-7140
Practice Address - Street 1:1200 N STATE ST STE 430
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39202-2027
Practice Address - Country:US
Practice Address - Phone:601-487-7141
Practice Address - Fax:601-487-7140
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS857552363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02975334Medicaid