Provider Demographics
NPI:1699592725
Name:BATES, LETISHA ANNE (BS, LPN)
Entity type:Individual
Prefix:
First Name:LETISHA
Middle Name:ANNE
Last Name:BATES
Suffix:
Gender:F
Credentials:BS, LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:TN
Mailing Address - Zip Code:37096-5058
Mailing Address - Country:US
Mailing Address - Phone:931-332-6801
Mailing Address - Fax:
Practice Address - Street 1:40 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:TN
Practice Address - Zip Code:37096-5058
Practice Address - Country:US
Practice Address - Phone:931-332-6801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist