Provider Demographics
NPI:1952628307
Name:BATEMAN, RENAE LYN (FNP)
Entity Type:Individual
Prefix:MS
First Name:RENAE
Middle Name:LYN
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12455 E 100TH ST N STE 260
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-4676
Mailing Address - Country:US
Mailing Address - Phone:918-274-5560
Mailing Address - Fax:918-403-6336
Practice Address - Street 1:12455 E 100TH ST N STE 260
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4676
Practice Address - Country:US
Practice Address - Phone:417-781-5387
Practice Address - Fax:417-781-7174
Is Sole Proprietor?:No
Enumeration Date:2010-04-26
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010008659363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200642440AMedicaid
MO1952628307Medicaid
OK200284530AMedicaid
MOMA2082130Medicare PIN