Provider Demographics
NPI:1720709744
Name:BATES, CASEY MAE (FNP)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:MAE
Last Name:BATES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MRS
Other - First Name:CASEY
Other - Middle Name:MAE
Other - Last Name:BATES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:2328 KNOB CREEK RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37604-2584
Mailing Address - Country:US
Mailing Address - Phone:423-722-1311
Mailing Address - Fax:
Practice Address - Street 1:2328 KNOB CREEK RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-2584
Practice Address - Country:US
Practice Address - Phone:423-722-1311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32159363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily