Provider Demographics
NPI:1912681115
Name:BATES, JESSICA ANNE (AGNP)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ANNE
Last Name:BATES
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Gender:
Credentials:AGNP
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Mailing Address - Street 1:801 ROSEHILL RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-1762
Mailing Address - Country:US
Mailing Address - Phone:517-212-2008
Mailing Address - Fax:517-212-9023
Practice Address - Street 1:4760 FASHION SQUARE BLVD STE L-1
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48604-2620
Practice Address - Country:US
Practice Address - Phone:989-282-4003
Practice Address - Fax:888-491-7220
Is Sole Proprietor?:No
Enumeration Date:2023-06-09
Last Update Date:2025-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI23151014417363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology