Healthcare Provider Details

I. General information

NPI: 1316409881
Provider Name (Legal Business Name): KELSEY RAE BARTOLETTI FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2019
Last Update Date: 08/04/2023
Certification Date: 08/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WHEELING AVE
GLEN DALE WV
26038-1697
US

IV. Provider business mailing address

3855 SHORT ST
SHADYSIDE OH
43947-1323
US

V. Phone/Fax

Practice location:
  • Phone: 304-974-5000
  • Fax:
Mailing address:
  • Phone: 724-825-8690
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN84336
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: