Healthcare Provider Details

I. General information

NPI: 1316836794
Provider Name (Legal Business Name): JAZLYN KATE BATES MSN, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAZLYN KATE BROSSART

II. Dates (important events)

Enumeration Date: 07/01/2025
Last Update Date: 07/01/2025
Certification Date: 06/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 2ND AVE
ROLETTE ND
58366
US

IV. Provider business mailing address

401 2ND AVE
ROLETTE ND
58366
US

V. Phone/Fax

Practice location:
  • Phone: 701-246-3391
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202654
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: