Provider Demographics
NPI:1114428828
Name:BATES, PRECIOUS MONIQUE
Entity Type:Individual
Prefix:
First Name:PRECIOUS
Middle Name:MONIQUE
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 BATES RD
Mailing Address - Street 2:
Mailing Address - City:FRIERSON
Mailing Address - State:LA
Mailing Address - Zip Code:71027-2018
Mailing Address - Country:US
Mailing Address - Phone:318-947-0588
Mailing Address - Fax:318-532-6824
Practice Address - Street 1:701 BATES RD
Practice Address - Street 2:
Practice Address - City:FRIERSON
Practice Address - State:LA
Practice Address - Zip Code:71027-2018
Practice Address - Country:US
Practice Address - Phone:318-947-0588
Practice Address - Fax:318-532-6824
Is Sole Proprietor?:Yes
Enumeration Date:2018-02-27
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1114428828Medicaid