Provider Demographics
NPI:1316836794
Name:BATES, JAZLYN KATE (MSN, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:JAZLYN
Middle Name:KATE
Last Name:BATES
Suffix:
Gender:F
Credentials:MSN, PMHNP-BC
Other - Prefix:
Other - First Name:JAZLYN
Other - Middle Name:KATE
Other - Last Name:BROSSART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:ROLETTE
Mailing Address - State:ND
Mailing Address - Zip Code:58366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 2ND AVE
Practice Address - Street 2:
Practice Address - City:ROLETTE
Practice Address - State:ND
Practice Address - Zip Code:58366
Practice Address - Country:US
Practice Address - Phone:701-246-3391
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-01
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND202654363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health