Provider Demographics
NPI:1972013407
Name:BATES, MICHELLE (APRN)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:BATES
Suffix:
Gender:
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAKEVIEW LN
Mailing Address - Street 2:
Mailing Address - City:IRONTON
Mailing Address - State:OH
Mailing Address - Zip Code:45638-8097
Mailing Address - Country:US
Mailing Address - Phone:740-547-4287
Mailing Address - Fax:740-532-1715
Practice Address - Street 1:700 PARK AVE
Practice Address - Street 2:
Practice Address - City:IRONTON
Practice Address - State:OH
Practice Address - Zip Code:45638-1502
Practice Address - Country:US
Practice Address - Phone:740-532-1613
Practice Address - Fax:740-532-1715
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2025-03-18
Deactivation Date:2024-10-07
Deactivation Code:
Reactivation Date:2024-10-23
Provider Licenses
StateLicense IDTaxonomies
WV114746363LF0000X
KY4036600363LF0000X
OH0037761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily