Provider Demographics
NPI:1679178339
Name:GATES, CHARITY MARKHAM (MSN, APRN, CPNP-PC)
Entity Type:Individual
Prefix:
First Name:CHARITY
Middle Name:MARKHAM
Last Name:GATES
Suffix:
Gender:F
Credentials:MSN, APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12381 INDIAN CREEK DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76179-6640
Mailing Address - Country:US
Mailing Address - Phone:817-688-0866
Mailing Address - Fax:
Practice Address - Street 1:604 E BAILEY BOSWELL RD STE 140
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:TX
Practice Address - Zip Code:76131-3568
Practice Address - Country:US
Practice Address - Phone:817-484-6610
Practice Address - Fax:817-570-0181
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1005236363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics