Healthcare Provider Details

I. General information

NPI: 1184688855
Provider Name (Legal Business Name): BILLIE BARTLEY PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: BILLIE RATLIFF

II. Dates (important events)

Enumeration Date: 04/12/2006
Last Update Date: 01/26/2024
Certification Date: 01/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 ADAMS LN SUITE 600-700
PIKEVILLE KY
41501-3087
US

IV. Provider business mailing address

140 ADAMS LN SUITE 600-700
PIKEVILLE KY
41501-3087
US

V. Phone/Fax

Practice location:
  • Phone: 606-509-2000
  • Fax: 606-509-2002
Mailing address:
  • Phone: 606-509-2000
  • Fax: 606-509-2002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA584
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: