Provider Demographics
NPI:1649559162
Name:KATES, JAMIE S (PA)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:S
Last Name:KATES
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:595 PRICE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1464
Mailing Address - Country:US
Mailing Address - Phone:650-701-1460
Mailing Address - Fax:
Practice Address - Street 1:595 PRICE AVE STE 200
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1464
Practice Address - Country:US
Practice Address - Phone:650-701-1460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21640363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant