Basic Information
| Provider Information | |||||||||
| NPI: | 1487886560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BATES | ||||||||
| FirstName: | BRANDY | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20 W 1700 S | ||||||||
| Address2: | |||||||||
| City: | CLEARFIELD | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840166004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014164474 | ||||||||
| FaxNumber: | 8014164636 | ||||||||
| Practice Location | |||||||||
| Address1: | 20 W 1700 S | ||||||||
| Address2: | |||||||||
| City: | CLEARFIELD | ||||||||
| State: | UT | ||||||||
| PostalCode: | 840166004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8014164474 | ||||||||
| FaxNumber: | 8014164636 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2009 | ||||||||
| LastUpdateDate: | 05/06/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA-808 | ID | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363AM0700X | 11217957-1206 | UT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.