Provider Demographics
NPI:1477556033
Name:BATES, FREIDA CARROLYN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:FREIDA
Middle Name:CARROLYN
Last Name:BATES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:BORGER
Mailing Address - State:TX
Mailing Address - Zip Code:79007-7579
Mailing Address - Country:US
Mailing Address - Phone:936-328-9990
Mailing Address - Fax:
Practice Address - Street 1:1518 RALSTON BRANCH WAY
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:936-328-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-27
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX452164367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX83815UOtherBCBSTX
TX8490UBOtherBCBS
TX003492803Medicaid
TX163477609Medicaid
TX8754UAOtherBCBSTX
TX163477602Medicaid
TX86620UOtherBCBSTX
TX8F3181Medicare PIN
TX163477602Medicaid
TX86620UOtherBCBSTX
TX8490UBOtherBCBS