Provider Demographics
NPI:1366046195
Name:BATES, KELLI (CRNP)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:KELLI
Other - Middle Name:BATES
Other - Last Name:PAYNE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2570 VILLAGE PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:OPELIKA
Mailing Address - State:AL
Mailing Address - Zip Code:36801-2380
Mailing Address - Country:US
Mailing Address - Phone:334-528-6320
Mailing Address - Fax:
Practice Address - Street 1:2570 VILLAGE PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:OPELIKA
Practice Address - State:AL
Practice Address - Zip Code:36801-2380
Practice Address - Country:US
Practice Address - Phone:334-528-4339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-159787363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner