Provider Demographics
NPI:1104413368
Name:BATES, KAYLA NICOLE
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:NICOLE
Last Name:BATES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11810 PYRITE RD
Mailing Address - Street 2:
Mailing Address - City:MANOR
Mailing Address - State:TX
Mailing Address - Zip Code:78653-2360
Mailing Address - Country:US
Mailing Address - Phone:740-245-2316
Mailing Address - Fax:
Practice Address - Street 1:9390 RESEARCH BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-6585
Practice Address - Country:US
Practice Address - Phone:512-330-9520
Practice Address - Fax:512-682-0089
Is Sole Proprietor?:No
Enumeration Date:2020-12-22
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant