Provider Demographics
NPI:1912510777
Name:BATES, KELSEY LYNN (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:LYNN
Last Name:BATES
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 276
Mailing Address - Street 2:
Mailing Address - City:HEALDTON
Mailing Address - State:OK
Mailing Address - Zip Code:73438-0276
Mailing Address - Country:US
Mailing Address - Phone:580-229-1111
Mailing Address - Fax:580-229-2045
Practice Address - Street 1:11053 HIGHWAY 76
Practice Address - Street 2:
Practice Address - City:HEALDTON
Practice Address - State:OK
Practice Address - Zip Code:73438-1721
Practice Address - Country:US
Practice Address - Phone:580-229-1111
Practice Address - Fax:580-229-2045
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0114570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily