Provider Demographics
NPI:1629518683
Name:BATES, NICOLE DANISE (APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:DANISE
Last Name:BATES
Suffix:
Gender:F
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 FAIRWAY DR
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-8105
Mailing Address - Country:US
Mailing Address - Phone:870-718-6329
Mailing Address - Fax:
Practice Address - Street 1:8907 KANIS RD STE 330
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6451
Practice Address - Country:US
Practice Address - Phone:501-224-8810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005024363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR581274YN39OtherPTAN