Provider Demographics
NPI:1780837823
Name:BATES, KATHY (CNA)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:
Last Name:BATES
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9958 POSEIDON DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-4508
Mailing Address - Country:US
Mailing Address - Phone:907-344-8253
Mailing Address - Fax:907-344-2171
Practice Address - Street 1:9958 POSEIDON DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-4508
Practice Address - Country:US
Practice Address - Phone:907-344-8253
Practice Address - Fax:907-344-2171
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2008-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK921526177F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes177F00000XOther Service ProvidersLodging