Provider Demographics
NPI:1508475765
Name:BATES, MOLLY JEAN (FNP)
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:JEAN
Last Name:BATES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5219 CITY BANK PKWY STE 35
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-3545
Mailing Address - Country:US
Mailing Address - Phone:806-761-0333
Mailing Address - Fax:
Practice Address - Street 1:808 JOLIET AVE UNIT 110
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79415-1148
Practice Address - Country:US
Practice Address - Phone:806-761-0320
Practice Address - Fax:806-761-0546
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145013363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily