Provider Demographics
NPI:1518418417
Name:BATES, MELINDA KAYE
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:KAYE
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 1:135 AUBURN DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-7557
Mailing Address - Country:US
Mailing Address - Phone:740-252-1092
Mailing Address - Fax:
Practice Address - Street 1:1310 HILL RD N STE 104
Practice Address - Street 2:
Practice Address - City:PICKERINGTON
Practice Address - State:OH
Practice Address - Zip Code:43147-7816
Practice Address - Country:US
Practice Address - Phone:614-962-6488
Practice Address - Fax:614-962-6489
Is Sole Proprietor?:No
Enumeration Date:2016-10-17
Last Update Date:2022-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHF1016039363LF0000X
OHAPRN.CNP.020072363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily