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General NPI Number Information
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NPI Number | 1043438187
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Entity Type | Individual
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Provider Name | DR. KATHERINE JO BARTLETT
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Gender | Female
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 07/14/2022
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Provider Practice Location Address
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Address Line | 208 HOSPITAL DR NE
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City | FORT WALTON BEACH
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State | FL
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Zip | 32548-5068
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Country | US
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Telephone | 850-243-8124
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Fax |
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Provider Business Mailing Address
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Address Line | 705 SIXTH ST
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City | DESTIN
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State | FL
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Zip | 32541-1902
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Country | US
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Telephone | 850-305-3677
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DN15622
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License Number State | FL
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