Provider Demographics
NPI:1265031074
Name:BATES, GIDGETT MARIE (PMHNP)
Entity type:Individual
Prefix:
First Name:GIDGETT
Middle Name:MARIE
Last Name:BATES
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5500 KELL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-1612
Mailing Address - Country:US
Mailing Address - Phone:940-264-2273
Mailing Address - Fax:940-264-7379
Practice Address - Street 1:5500 KELL BLVD STE 100
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76310-1612
Practice Address - Country:US
Practice Address - Phone:940-264-2273
Practice Address - Fax:940-264-7379
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017545363L00000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner