Provider Demographics
NPI:1053391037
Name:BATES, ALICIA KAY (NP)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:KAY
Last Name:BATES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 HIGH ST
Mailing Address - Street 2:STE 2
Mailing Address - City:DECATUR
Mailing Address - State:IN
Mailing Address - Zip Code:46733-2326
Mailing Address - Country:US
Mailing Address - Phone:260-724-8700
Mailing Address - Fax:260-728-3821
Practice Address - Street 1:1100 MERCER AVE
Practice Address - Street 2:
Practice Address - City:DECATUR
Practice Address - State:IN
Practice Address - Zip Code:46733-2303
Practice Address - Country:US
Practice Address - Phone:260-724-2145
Practice Address - Fax:260-724-2145
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001926A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000373877OtherANTHEM
IN200530800Medicaid
IN000000373877OtherANTHEM
Q50937Medicare UPIN