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General NPI Number Information
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NPI Number | 1699055491
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Entity Type | Individual
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Provider Name | NICOLE DAWN BARTLETT DNP, AGACNP-BC, PNP
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Gender | Female
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Dates
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Enumeration Date | 08/24/2011
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Last Update Date | 04/27/2021
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Provider Practice Location Address
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Address Line | 562 SHOUP AVE W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5029
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Country | US
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Telephone | 208-734-0407
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Fax |
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Provider Business Mailing Address
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Address Line | 562 SHOUP AVE W
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City | TWIN FALLS
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State | ID
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Zip | 83301-5029
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Country | US
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Telephone | 208-736-7422
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Fax | 208-333-9582
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | NP1111A
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 23203A
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | NP1111A
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License Number State | ID
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Taxonomy #4
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | NP1111A
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License Number State | ID
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