Healthcare Provider Details

I. General information

NPI: 1891754800
Provider Name (Legal Business Name): RICHARD DANIEL BATES JR. FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9841 NORTHLAKE CENTRE PKWY
CHARLOTTE NC
28216-8930
US

IV. Provider business mailing address

9841 NORTHLAKE CENTRE PKWY
CHARLOTTE NC
28216-8930
US

V. Phone/Fax

Practice location:
  • Phone: 704-526-3648
  • Fax:
Mailing address:
  • Phone: 866-389-2727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number42165
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4060570
License Number StateKY
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number201249
License Number StateNC
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201249
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: