Provider Demographics
NPI:1508318478
Name:BATES, LAURA
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 E WATER ST
Mailing Address - Street 2:
Mailing Address - City:FARMERVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71241-3120
Mailing Address - Country:US
Mailing Address - Phone:318-407-6147
Mailing Address - Fax:888-437-6915
Practice Address - Street 1:604 E WATER ST
Practice Address - Street 2:
Practice Address - City:FARMERVILLE
Practice Address - State:LA
Practice Address - Zip Code:71241-3120
Practice Address - Country:US
Practice Address - Phone:318-407-6147
Practice Address - Fax:888-437-6915
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-26
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP090582084P0800X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2433229Medicaid