Healthcare Provider Details

I. General information

NPI: 1699055491
Provider Name (Legal Business Name): NICOLE DAWN BARTLETT DNP, AGACNP-BC, PNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE DAWN BARTLETT

II. Dates (important events)

Enumeration Date: 08/24/2011
Last Update Date: 04/27/2021
Certification Date: 04/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

562 SHOUP AVE W
TWIN FALLS ID
83301-5029
US

IV. Provider business mailing address

562 SHOUP AVE W
TWIN FALLS ID
83301-5029
US

V. Phone/Fax

Practice location:
  • Phone: 208-734-0407
  • Fax:
Mailing address:
  • Phone: 208-736-7422
  • Fax: 208-333-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberNP1111A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number23203A
License Number StateID
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNP1111A
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberNP1111A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: