Healthcare Provider Details

I. General information

NPI: 1972254423
Provider Name (Legal Business Name): KATLYN C BATES APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2022
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 GLENN HENDREN DR
LIBERTY MO
64068-9625
US

IV. Provider business mailing address

16187 HIGHWAY M
LAWSON MO
64062-9283
US

V. Phone/Fax

Practice location:
  • Phone: 816-407-5430
  • Fax:
Mailing address:
  • Phone: 816-588-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2017022410
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2022026229
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number53-85205
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: