MEDICARE: CAROLINE GATES MSN, RN, CDCES

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	163WD0400X	Diabetes Educator Registered Nurse	32301209	VA
2	163W00000X	Registered Nurse	0001319444	VA

General Provider Information

NPI Number	:	1902760473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE GATES MSN, RN, CDCES

Provider Business Mailing Address
First Line	:	4717 ARLINGTON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2612
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4717 ARLINGTON BLVD
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-2612
Country	:	US
Telephone Number	:	864-642-8629
Fax Number	:

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

Provider Enumeration Date	:	12/10/2025
Last Update Date	:	12/10/2025

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