Provider Demographics
NPI:1699332692
Name:BATES, YOLANDA ROSHELL (AGNP-C)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:ROSHELL
Last Name:BATES
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:ROSHELL
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5304 E 5TH ST STE 113
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-2532
Mailing Address - Country:US
Mailing Address - Phone:346-307-7500
Mailing Address - Fax:866-850-7784
Practice Address - Street 1:5304 E 5TH ST STE 113
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77493-2532
Practice Address - Country:US
Practice Address - Phone:346-307-7500
Practice Address - Fax:346-307-7570
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX30275163WG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0600XNursing Service ProvidersRegistered NurseGerontology