Provider Demographics
NPI:1083599294
Name:BATES, TALIQ AYSHUN
Entity type:Individual
Prefix:
First Name:TALIQ
Middle Name:AYSHUN
Last Name:BATES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 TEMPLE ST
Mailing Address - Street 2:
Mailing Address - City:BECKLEY
Mailing Address - State:WV
Mailing Address - Zip Code:25801-4043
Mailing Address - Country:US
Mailing Address - Phone:681-222-8323
Mailing Address - Fax:
Practice Address - Street 1:507 TEMPLE ST
Practice Address - Street 2:
Practice Address - City:BECKLEY
Practice Address - State:WV
Practice Address - Zip Code:25801-4043
Practice Address - Country:US
Practice Address - Phone:681-222-8323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-07
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant