Provider Demographics
NPI:1851151005
Name:BATES, TARA ASHLI (MD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:ASHLI
Last Name:BATES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3250 VINEYARD DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72032-8058
Mailing Address - Country:US
Mailing Address - Phone:501-952-1612
Mailing Address - Fax:
Practice Address - Street 1:3250 VINEYARD DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-8058
Practice Address - Country:US
Practice Address - Phone:501-952-1612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-21
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program