Provider Demographics
NPI:1932989761
Name:GATES, TABATHA KRISTI
Entity Type:Individual
Prefix:
First Name:TABATHA
Middle Name:KRISTI
Last Name:GATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2697 S SEDGE LN
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-6923
Mailing Address - Country:US
Mailing Address - Phone:231-629-9642
Mailing Address - Fax:
Practice Address - Street 1:1040 N TOWERLINE RD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-9466
Practice Address - Country:US
Practice Address - Phone:231-629-9642
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator