MEDICARE: DR. JENNA LEE BATES DO

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	207R00000X	Internal Medicine Physician	5937	OK
2	207R00000X	Internal Medicine Physician	S3629	TX
3	207R00000X	Internal Medicine Physician	80160	GA

General Provider Information

NPI Number	:	1356729297
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNA LEE BATES DO

Provider Business Mailing Address
First Line	:	6100 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4101
Country	:	US
Telephone Number	:	817-433-5977
Fax Number	:

Provider Business Practice Location Address
First Line	:	6100 HARRIS PKWY
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4101
Country	:	US
Telephone Number	:	817-433-5977
Fax Number	:

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

Provider Enumeration Date	:	05/12/2015
Last Update Date	:	01/26/2026

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