Provider Demographics
NPI:1982734117
Name:BATEMAN, LORIE L (PA-C)
Entity Type:Individual
Prefix:
First Name:LORIE
Middle Name:L
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8033 RAY MEARS BLVD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-670-2383
Mailing Address - Fax:
Practice Address - Street 1:259 N PETERS RD STE 103
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4923
Practice Address - Country:US
Practice Address - Phone:865-690-1255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2679363AM0700X
GA004305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA051787607BMedicaid
GA051787607AMedicaid
GA97WCJLHMedicare PIN
GA511I970016Medicare PIN
GA051787607BMedicaid