MEDICARE: CASEY MAE BATES FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	32159	TN

General Provider Information

NPI Number	:	1720709744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CASEY MAE BATES FNP

Provider Business Mailing Address
First Line	:	2328 KNOB CREEK RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2584
Country	:	US
Telephone Number	:	423-722-1311
Fax Number	:

Provider Business Practice Location Address
First Line	:	2328 KNOB CREEK RD
Second Line	:
City	:	JOHNSON CITY
State	:	TN
Zip	:	37604-2584
Country	:	US
Telephone Number	:	423-722-1311
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2022
Last Update Date	:	09/07/2022

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