Provider Demographics
NPI:1952059420
Name:BARTLEY, STEPHANIE TURNER (DIRECTOR)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TURNER
Last Name:BARTLEY
Suffix:
Gender:F
Credentials:DIRECTOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 FOXGLOVE DR
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:LA
Mailing Address - Zip Code:70392-5735
Mailing Address - Country:US
Mailing Address - Phone:985-992-7045
Mailing Address - Fax:
Practice Address - Street 1:107 FOXGLOVE DR
Practice Address - Street 2:
Practice Address - City:PATTERSON
Practice Address - State:LA
Practice Address - Zip Code:70392-5735
Practice Address - Country:US
Practice Address - Phone:985-992-7045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory