Provider Demographics
NPI:1912474511
Name:BATES, DEMETRIA SHAWNTE (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:DEMETRIA
Middle Name:SHAWNTE
Last Name:BATES
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 457
Mailing Address - Street 2:
Mailing Address - City:WHITE SULPHUR SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:24986-0457
Mailing Address - Country:US
Mailing Address - Phone:304-536-5030
Mailing Address - Fax:866-903-6621
Practice Address - Street 1:200 ARH LANE
Practice Address - Street 2:SUITE 400
Practice Address - City:LOW MOOR
Practice Address - State:VA
Practice Address - Zip Code:24457-0007
Practice Address - Country:US
Practice Address - Phone:540-862-7064
Practice Address - Fax:540-862-5727
Is Sole Proprietor?:No
Enumeration Date:2018-11-01
Last Update Date:2018-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176832363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily