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General NPI Number Information
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NPI Number | 1255506929
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Entity Type | Individual
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Provider Name | JENNIE JON BATA APRN/DNP/PMHNP/FNP
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Gender | Female
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Dates
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Enumeration Date | 04/24/2008
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 813 S POKEGAMA AVE LOWER LEVEL
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City | GRAND RAPIDS
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State | MN
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Zip | 55744
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Country | US
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Telephone | 218-297-1900
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Fax |
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Provider Business Mailing Address
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Address Line | 813 S POKEGAMA AVE STE B
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City | GRAND RAPIDS
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State | MN
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Zip | 55744-3934
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Country | US
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Telephone | 701-331-3989
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 7612
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R30139
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License Number State | ND
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 7612
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R30139
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License Number State | ND
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