Provider Demographics
NPI:1891070330
Name:BATES, KIMBERLY MELISSA (ARNP)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:MELISSA
Last Name:BATES
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-868-8364
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:699 W COCOA BEACH CSWY
Practice Address - Street 2:SUITE 603
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3577
Practice Address - Country:US
Practice Address - Phone:321-868-8364
Practice Address - Fax:321-868-8372
Is Sole Proprietor?:No
Enumeration Date:2011-10-16
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9334301363L00000X, 363LW0102X
FLAPRN9334301363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004475500Medicaid
FLFR816YOtherMEDICARE