Individual
MARY BETH HARTLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
1400 W 4TH ST, COFFEYVILLE, KS 67337-3306
(620) 688-6566
(620) 688-6577
Mailing address
PO BOX 505252, SAINT LOUIS, MO 63150-5262
(620) 688-6566
(620) 688-6577
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
45384
KS
363LF0000X
Family Nurse Practitioner
121186
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100446860D
—
KS
05
—
100446860G
—
KS
01
—
110385030
MEDICARE PTAN
KS
Enumeration date
07/07/2005
Last updated
11/30/2016
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