Provider Demographics
NPI:1679041230
Name:BARTLETT, KYLEE ANN (LMT)
Entity type:Individual
Prefix:
First Name:KYLEE
Middle Name:ANN
Last Name:BARTLETT
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 W 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-3977
Mailing Address - Country:US
Mailing Address - Phone:907-868-7821
Mailing Address - Fax:907-868-7584
Practice Address - Street 1:218 W 34TH AVE
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-3977
Practice Address - Country:US
Practice Address - Phone:907-868-7821
Practice Address - Fax:907-868-7584
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2018-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK133022225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AK133022OtherSTATE LICENSE