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General NPI Number Information
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NPI Number | 1841927092
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Entity Type | Individual
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Provider Name | SKYLAR BROOKE BARTLETT
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Gender | Female
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Dates
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Enumeration Date | 08/05/2022
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Last Update Date | 08/05/2022
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Provider Practice Location Address
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Address Line | 327 MEDICAL PARK DR
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City | BRIDGEPORT
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State | WV
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Zip | 26330-9006
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Country | US
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Telephone | 681-324-1000
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Fax |
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Provider Business Mailing Address
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Address Line | 73 EASTVIEW WAY
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City | FAIRMONT
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State | WV
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Zip | 26554-1781
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Country | US
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Telephone | 585-991-8507
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 102346
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License Number State | WV
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