=====================================================
General NPI Number Information
=====================================================
NPI Number | 1457928764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA M BATES PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/06/2021
-----------------------------------------------------
Last Update Date | 01/25/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1152 HERMES AVE
-----------------------------------------------------
City | ENCINITAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92024-1606
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-281-9342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1154
-----------------------------------------------------
City | MAKAWAO
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96768-1154
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-281-9342
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 95020063
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 346589
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------