Active NPI
Judy Ann Bartle, APRN, BC, FNPGNP
- Family Nurse Practitioner
- Sullivan, MO
National Provider Identifier
1245387422
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Nurse Practitioner
- License
- 113196
- Practice address
- 965 Mattox Dr
Sullivan, MO 63080-2365 - Phone
- (573) 860-6000
- Fax
- (573) 860-6016
- NPI assigned
- Jan 3, 2007
- Last updated
- Jul 21, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 113196 | MO | Primary |
Addresses
Primary practice location
965 Mattox Dr
Sullivan, MO 63080-2365
Mailing address
670 Mason Ridge Center Dr Ste 300
Saint Louis, MO 63141-8573
Phone (573) 860-6000
Other practice location 1
1605 Martin Springs Dr
Suite 320
Rolla, MO 65401-2931
Phone (573) 458-6370
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245387422 | Medicaid | MO | |
| 175738758 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 113196 | MO | MD | Family Nurse Practitioner |
Interoperability endpoints
- jbartle38081@directb.mercy.net
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167782400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1245387422",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "670 MASON RIDGE CENTER DR STE 300",
"city": "SAINT LOUIS",
"state": "MO",
"postal_code": "631418573",
"telephone_number": "573-860-6000",
"fax_number": "573-860-6016"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "965 MATTOX DR",
"city": "SULLIVAN",
"state": "MO",
"postal_code": "630802365",
"telephone_number": "573-860-6000",
"fax_number": "573-860-6016"
}
],
"practiceLocations": [
{
"address_1": "1605 Martin Springs Dr",
"address_2": "Suite 320",
"address_purpose": "LOCATION",
"city": "Rolla",
"state": "MO",
"postal_code": "654012931",
"country_code": "US",
"telephone_number": "573-458-6370",
"fax_number": "573-458-6847",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BARTLE",
"first_name": "JUDY",
"middle_name": "ANN",
"name_prefix": "Ms.",
"credential": "APRN, BC, FNPGNP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-01-03",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "363LF0000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Family",
"state": "MO",
"license": "113196",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1245387422",
"state": "MO"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "175738758",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sullivan, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.