Provider Demographics
NPI:1538581251
Name:BATES, JODY LYN (NP-C)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:LYN
Last Name:BATES
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 S STANFIELD RD
Mailing Address - Street 2:STE 301
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-2374
Mailing Address - Country:US
Mailing Address - Phone:937-339-1518
Mailing Address - Fax:937-339-1538
Practice Address - Street 1:31 S STANFIELD RD
Practice Address - Street 2:STE 301
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-2374
Practice Address - Country:US
Practice Address - Phone:937-339-1518
Practice Address - Fax:937-339-1538
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-15
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15552-NP363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099484Medicaid
OH0099484Medicaid
OHH279952Medicare PIN