Provider Demographics
NPI:1528398054
Name:BATES, REBECCA L (WHCNP)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:L
Last Name:BATES
Suffix:
Gender:F
Credentials:WHCNP
Other - Prefix:
Other - First Name:BECKY
Other - Middle Name:
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:504 CLINTON CENTER DRIVE
Mailing Address - Street 2:CBO SUITE 4300
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-4500
Mailing Address - Country:US
Mailing Address - Phone:601-815-2005
Mailing Address - Fax:601-984-6904
Practice Address - Street 1:2500 N STATE ST
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-5306
Practice Address - Fax:601-984-6904
Is Sole Proprietor?:No
Enumeration Date:2010-01-06
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR859551363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04138318Medicaid
MS302I427496Medicare PIN
MS04138318Medicaid
MS302I503121Medicare PIN
MSP01676212Medicare PIN