Healthcare Provider Details

I. General information

NPI: 1417712951
Provider Name (Legal Business Name): CHARMON BATES PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1681 MOUNT ZION RD
GRAND CANE LA
71032-6105
US

IV. Provider business mailing address

1681 MOUNT ZION RD
GRAND CANE LA
71032-6105
US

V. Phone/Fax

Practice location:
  • Phone: 318-402-8201
  • Fax: 318-404-1612
Mailing address:
  • Phone: 318-871-7350
  • Fax: 318-404-1612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number248543
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: