1437151982 NPI number — MS. MARY KAY HARTLEY ACNP

Table of content: MS. MARY KAY HARTLEY ACNP (NPI 1437151982)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437151982 NPI number — MS. MARY KAY HARTLEY ACNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARTLEY
Provider First Name:
MARY
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
ACNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARTLEY
Provider Other First Name:
MARY KAY
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ACNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1437151982
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4375 BOOTH CALLOWAY
Provider Second Line Business Mailing Address:
STE 307
Provider Business Mailing Address City Name:
NORTH RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76180-8362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-284-4343
Provider Business Mailing Address Fax Number:
817-590-4393

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4375 BOOTH CALLOWAY
Provider Second Line Business Practice Location Address:
STE 307
Provider Business Practice Location Address City Name:
NORTH RICHLAND HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76180-8362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-284-4343
Provider Business Practice Location Address Fax Number:
817-590-4393
Provider Enumeration Date:
08/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2100X , with the licence number:  515399 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 192926701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com