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General NPI Number Information
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NPI Number | 1184573032
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Entity Type | Organization
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Legal Business Name | BRANDY M BATES, LLC
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Dates
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Enumeration Date | 01/23/2026
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Last Update Date | 01/23/2026
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Provider Practice Location Address
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Address Line | 2434 S FAIRWAY DR
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City | POCATELLO
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State | ID
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Zip | 83201-2372
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Country | US
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Telephone | 208-851-9151
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Fax | 208-977-0029
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Provider Business Mailing Address
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Address Line | 2434 S FAIRWAY DR
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City | POCATELLO
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State | ID
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Zip | 83201-2372
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Country | US
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Telephone | 208-851-9151
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Fax | 208-977-0029
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | BRANDY M BATES
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Credential | DMSC, PA-C, CAQ-PSYC
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Telephone | 208-851-9151
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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