Provider Demographics
NPI:1114499894
Name:BATEMAN, AUDREY ELIZABETH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:AUDREY
Middle Name:ELIZABETH
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E COTTAGE AVE
Mailing Address - Street 2:
Mailing Address - City:WEST CARROLLTON
Mailing Address - State:OH
Mailing Address - Zip Code:45449-1354
Mailing Address - Country:US
Mailing Address - Phone:937-371-4313
Mailing Address - Fax:
Practice Address - Street 1:900 S DIXIE DR STE 40
Practice Address - Street 2:
Practice Address - City:VANDALIA
Practice Address - State:OH
Practice Address - Zip Code:45377-2656
Practice Address - Country:US
Practice Address - Phone:937-890-6644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLE-00026079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily