Healthcare Provider Details

I. General information

NPI: 1679412852
Provider Name (Legal Business Name): MISS KARLEY DIANE BATES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2026
Last Update Date: 03/25/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 MEDICAL CENTER DRIVE
MORGANTOWN WV
26506
US

IV. Provider business mailing address

112 CREEK VIEW CT
MOUNT HOLLY NC
28120-9252
US

V. Phone/Fax

Practice location:
  • Phone: 304-293-6208
  • Fax:
Mailing address:
  • Phone: 704-956-7153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: