Healthcare Provider Details

I. General information

NPI: 1093456006
Provider Name (Legal Business Name): ASHLYN MAE BATEMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/05/2022
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 W GREEN OAKS BLVD STE B
ARLINGTON TX
76013-8333
US

IV. Provider business mailing address

4221 BENNER STE 250
KYLE TX
78640-2220
US

V. Phone/Fax

Practice location:
  • Phone: 817-457-3088
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number7067
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: