Provider Demographics
NPI:1467866343
Name:BATES, TERESA (LVN)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 CIRCLE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76119-8118
Mailing Address - Country:US
Mailing Address - Phone:817-413-6312
Mailing Address - Fax:817-413-6313
Practice Address - Street 1:1500 CIRCLE DR STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76119-8118
Practice Address - Country:US
Practice Address - Phone:817-413-6312
Practice Address - Fax:817-413-6313
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153707164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse