Provider Demographics
NPI:1699047894
Name:GATES, CAROLINE ELISABETH (NP-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:ELISABETH
Last Name:GATES
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 1:5000 ALPHA LN
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-4054
Mailing Address - Country:US
Mailing Address - Phone:423-870-1662
Mailing Address - Fax:423-877-4845
Practice Address - Street 1:5000 ALPHA LN
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-4054
Practice Address - Country:US
Practice Address - Phone:423-870-1662
Practice Address - Fax:423-877-4845
Is Sole Proprietor?:No
Enumeration Date:2012-02-02
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704232189363LF0000X
TNAPN0000016421363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1527191Medicaid
TN4321881OtherBCBS OF TN
TN103I509917Medicare PIN