MEDICARE: KALA BARTLETT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN9320814	FL
2	363LF0000X	Family Nurse Practitioner	APRN9320814	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235637943
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KALA BARTLETT APRN

Provider Business Mailing Address
First Line	:	879 SE WATERSIDE WAY
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34997-2825
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 N FLAGLER DR STE 3000
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33401-3425
Country	:	US
Telephone Number	:	561-253-4395
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/28/2018
Last Update Date	:	11/24/2021

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Directions to “ KALA BARTLETT APRN” Practice Location

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