Healthcare Provider Details

I. General information

NPI: 1265452809
Provider Name (Legal Business Name): KIN D BATES SR. PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 09/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3330 CHURN CREEK RD STE D4
REDDING CA
96002-2532
US

IV. Provider business mailing address

2126 EUREKA WAY
REDDING CA
96001-0427
US

V. Phone/Fax

Practice location:
  • Phone: 530-222-3287
  • Fax: 530-222-8547
Mailing address:
  • Phone: 530-244-3278
  • Fax: 530-244-3280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: