Provider Demographics
NPI:1053111351
Name:BARTLETT, LEIDY KATHERINE (RN, CCRN)
Entity type:Individual
Prefix:
First Name:LEIDY
Middle Name:KATHERINE
Last Name:BARTLETT
Suffix:
Gender:
Credentials:RN, CCRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CHELSEA ST SW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30120-6935
Mailing Address - Country:US
Mailing Address - Phone:404-918-1652
Mailing Address - Fax:
Practice Address - Street 1:310 CHELSEA ST SW
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30120-6935
Practice Address - Country:US
Practice Address - Phone:404-918-1652
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN289371163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse