Provider Demographics
NPI:1922039536
Name:GATES, PATRICIA L (ARNP, BSN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:L
Last Name:GATES
Suffix:
Gender:F
Credentials:ARNP, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 S JACKSON ST FL ST2
Mailing Address - Street 2:DEPT OB/GYN ATT: VICKI MASTERSON
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1622
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 E CHESTNUT ST
Practice Address - Street 2:SUITE 410
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5700
Practice Address - Country:US
Practice Address - Phone:502-271-5999
Practice Address - Fax:502-271-5994
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2008-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2238P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000542620OtherANTHEM FOUNDATIN
KY50012467OtherPASSPORT-SPECIALTY PSC
KY000000045421OtherANTHEM PSC
KY50012470OtherPASSPORT- PCP FOUNDATION
KY78017274Medicaid
KY50012469OtherPASSPORT-SPECIALITY FOUNDATION
IN200410210Medicaid
KYS96252Medicare UPIN