Provider Demographics
NPI:1659957892
Name:GATES, ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:GATES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2245 GREEN BRIAR COVE RD
Mailing Address - Street 2:
Mailing Address - City:UNION GROVE
Mailing Address - State:AL
Mailing Address - Zip Code:35175-8362
Mailing Address - Country:US
Mailing Address - Phone:256-509-1423
Mailing Address - Fax:
Practice Address - Street 1:4704 WHITESBURG DR SW STE 201
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35802-1681
Practice Address - Country:US
Practice Address - Phone:256-489-5215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-166147363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner