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General NPI Number Information
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NPI Number | 1770739492
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Entity Type | Individual
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Provider Name | KENNETH BOYD BATES PA-C
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Gender | Male
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Dates
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Enumeration Date | 08/13/2008
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Last Update Date | 03/12/2019
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Provider Practice Location Address
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Address Line | 411 W TIPTON ST
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City | SEYMOUR
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State | IN
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Zip | 47274-2363
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Country | US
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Telephone | 812-524-3311
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Fax | 812-524-3310
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Provider Business Mailing Address
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Address Line | 411 W TIPTON ST
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City | SEYMOUR
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State | IN
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Zip | 47274-2363
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Country | US
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Telephone | 181-252-2234
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10001207A
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License Number State | IN
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