MEDICARE: TRACY D BATES APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	77661	KS
2	363L00000X	Nurse Practitioner	93880	OK

General Provider Information

NPI Number	:	1174063580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY D BATES APRN

Provider Business Mailing Address
First Line	:	131 W. MARKET, SUITE B
Second Line	:
City	:	OSAGE CITY
State	:	KS
Zip	:	66523-1099
Country	:	US
Telephone Number	:	918-633-6899
Fax Number	:

Provider Business Practice Location Address
First Line	:	131 W MARKET ST STE B
Second Line	:
City	:	OSAGE CITY
State	:	KS
Zip	:	66523-1099
Country	:	US
Telephone Number	:	918-633-6899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2017
Last Update Date	:	07/21/2022

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