Provider Demographics
NPI:1457684490
Name:BATES, CARRIE LYN (PA-C)
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYN
Last Name:BATES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8111 S 21ST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-7755
Mailing Address - Country:US
Mailing Address - Phone:480-783-7000
Mailing Address - Fax:480-783-9071
Practice Address - Street 1:13838 S 46TH PL STE 125
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7802
Practice Address - Country:US
Practice Address - Phone:480-783-7000
Practice Address - Fax:480-783-9071
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4484363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant