Provider Demographics
NPI:1558319566
Name:BATES, TEENA JANE (RN,CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TEENA
Middle Name:JANE
Last Name:BATES
Suffix:
Gender:F
Credentials:RN,CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76703-0662
Mailing Address - Country:US
Mailing Address - Phone:254-767-2929
Mailing Address - Fax:254-757-3015
Practice Address - Street 1:510 S 12TH ST
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76706-1712
Practice Address - Country:US
Practice Address - Phone:254-757-2929
Practice Address - Fax:254-757-3015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX526016363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics