Provider Demographics
NPI:1225811581
Name:BATES, ELIZABETH ANN (BS HUMAN NUTRITION)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:BATES
Suffix:
Gender:
Credentials:BS HUMAN NUTRITION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:527 TUSKEGEE AIRMEN AIRMEN AVE.
Mailing Address - Street 2:
Mailing Address - City:SHEPPARD AIR FORCE BASE
Mailing Address - State:TX
Mailing Address - Zip Code:76311-3478
Mailing Address - Country:US
Mailing Address - Phone:904-504-5955
Mailing Address - Fax:
Practice Address - Street 1:527 TUSKEGEE AIRMEN AVE
Practice Address - Street 2:
Practice Address - City:SHEPPARD AIR FORCE BASE
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:904-504-9555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO86113177133V00000X
TX86113177133VN1501X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1501XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Sports Dietetics
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered