| Doctor Name: | MARY BETH HARTLEY |
| NPI Number: | 1073510764 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | APRN |
| License Number: | 121186 |
| Business Practice Address: | 801 W 8th St Coffeyville, KS - 673374109 |
| Business Phone Number: | 6206886566 |
| Business Fax Number: | 6206886577 |
| Mailing Address: | Po Box 505252, SAINT LOUIS |
| State: | MO |
| Postal Code: | 631505262 |
| Phone Number: | 6206886566 |
| Fax Number: | 6206886577 |
| NPI Enumeration Date: | 07/07/2005 |
| NPI Last Update Date: | 03/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 121186 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |